Sponsored by:
Assemblywoman PAMELA R. LAMPITT
District 6 (Burlington and Camden)
Assemblyman JOSEPH A. LAGANA
District 38 (Bergen and Passaic)
Assemblywoman NANCY J. PINKIN
District 18 (Middlesex)
Assemblyman HERB CONAWAY, JR.
District 7 (Burlington)
SYNOPSIS
Prohibits insurers from setting prices for non-covered dental services.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning certain dental benefit plans and supplementing P.L.1997, c.192 (C:26:2S-1 et seq.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. As used in this act:
“Carrier” means an insurance company, health service corporation, hospital service corporation, medical service corporation, dental service corporation, dental plan organization, or health maintenance organization, authorized to issue dental plans in this State.
"Covered person" means a person on whose behalf a carrier offering a dental plan is obligated to pay benefits or provide services pursuant to the plan.
"Covered service" means a dental care service provided to a covered person under a dental plan for which the carrier is obligated to pay benefits or provide services.
“Dental plan” means a benefits
plan which pays or provides dental expense benefits for covered services and is
delivered or issued for delivery in this State by or through a dental carrier.
2. Notwithstanding section 22 of P.L.1993, c.162 (C.17B:27A-54) or any other law or regulation to the contrary, a contract between a carrier and a dentist to provide covered services shall not require, directly or indirectly, that a dentist provide services to a covered person at a fee set by, or at a fee subject to the approval of, the carrier unless the dental services are a covered service under the person’s dental plan.
3. The Commissioner of Banking and Insurance shall promulgate rules and regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) necessary to effectuate the purposes of this act.
4. This act shall take effect immediately and shall apply to contracts entered into or renewed on or after the effective date of this act.
STATEMENT
This bill prohibits dental carriers from requiring, directly or indirectly, that a dentist provide services to a covered person at a fee set by, or at a fee subject to the approval of, the carrier unless the dental services are a covered service under the person’s dental plan.
This bill is, in part, a response to the decision in New Jersey Dental Ass’n v. Metropolitan Life Ins. Co., 424 N.J. Super. 160 (App. Div. 2012). In that decision, the court held that the “selective contracting law,” section 22 of P.L.1993, c.162 (C.17B:27A-54), authorized the Department of Banking and Insurance to issue regulations that allow managed care plans to negotiate the fees paid by their insureds to in-network providers for dental services that are not covered under the dental benefits plan. This bill would overturn that part of the decision and the effect of those regulations by prohibiting carriers from setting fees paid by their insureds for services that are not covered services under the insured’s dental plan.