(a) For any policy delivered, issued for delivery, renewed, amended or continued in this state that provides coverage for inpatient or outpatient dental services only, the person who issues the policy shall provide the insured or a licensed dentist acting on behalf of the insured, upon request, an estimate of reimbursement under the policy with respect to specific dental procedure codes ordered or recommended for the insured by a licensed dentist, except that the actual reimbursement may be adjusted based on factors such as the insured's eligibility, plan design, utilization of benefits and the actual claim submitted.
(b) No person that issues a policy described in subsection (a) of this section that uses a provider network for such policy shall materially adjust the fee schedule for in-network providers more than once annually.
(c) Each person that makes a material adjustment described in subsection (b) of this section shall issue a notice to each in-network provider at least ninety days before the effective date of such adjustment. Each such notice shall be sent by mail, electronic mail or facsimile, and disclose:
(1) The percentage effect that such adjustment will have on such provider's fees; or
(2) A measure, other than the measure described in subdivision (1) of this subsection, that will enable such provider to understand how such adjustment will affect such provider's fees for the twenty covered procedures that such provider most frequently performed, and for which such provider sought reimbursement, during the twelve months immediately preceding the date of such notice.
(P.A. 04-125, S. 1; P.A. 11-19, S. 7; P.A. 19-155, S. 3.)
History: P.A. 11-9 made a technical change; P.A. 19-155 designated existing provisions re policy that provides coverage for inpatient or outpatient dental services only as Subsec. (a) and added Subsecs. (b) and (c) re material adjustments to fee schedules for in-network providers, effective January 1, 2020.