HF1474

The bill, H.F. No. 1474, proposes changes to Minnesota Statutes 2024, section 62Q.78, subdivision 6, regarding insurance coverage for dental care services. Key modifications include:

1. Limitations on Dental Plan Fees:

   • A dental plan or organization cannot require dentists to offer services at a set fee unless the service is a covered service (i.e., reimbursable under the enrollee’s plan).
     
   • Dental networks cannot offer providers to a plan that sets dental fees for non-covered services.
     

2. Definition of Covered Services:

   • Defines covered services as those for which reimbursement is provided or would be provided under a plan, excluding contractual limitations like deductibles, copayments, coinsurance, and frequency caps.
     

3. Dentist Charges for Non-Covered Services:

   • Dentists cannot charge more than their usual and customary rates for services not covered by an insurance plan.
     
   • Treatment plan requirement: Before providing non-covered services, dentists must provide patients with a treatment plan, including anticipated procedures and estimated costs.
     

4. Preservation of Insurance Plan Authority:

   • The bill does not interfere with a dental plan's ability to regulate balance billing, waiting periods, frequency limitations, deductibles, or maximum annual benefits for covered services.
     

Purpose of the Bill:

This bill aims to ensure transparency and fairness in dental insurance by clarifying reimbursement rules and ensuring patients are informed of costs for non-covered services before receiving treatment.