Bill > A4996

Introduced Session

This bill requires insurance carriers offering dental benefit plans to provide covered persons with a certain level of coverage for covered services. Specifically, the bill requires dental plans offered by insurance carriers in this State to provide for a level of coverage that is designed to provide benefits that are actuarially equivalent to an amount of the full actuarial value of the benefits provided under the plan that shall be determined by the Commissioner of Banking and Insurance. The bill provides that the level of coverage of a dental plan is to be determined on the basis that the covered services are provided to a standard population, and without regard to the actual population to which the plan may provide benefits. The bill requires the Commissioner of Banking and Insurance to develop guidelines to provide for a de minimis variation in the actuarial calculations used in determining the level of coverage of a plan to account for differences in actuarial estimates. The bill also requires a dental plan offered by a carrier in this State to provide for reimbursement to a provider for a covered service at a level that is at least 75 percent of the usual and customary charge for the service provided. The bill requires the Commissioner of Banking and Insurance to develop procedures for the determination of the usual and customary charge for dental services on a regional basis within the State. Determinations for reimbursement of dental services are required to be made, at a minimum, for three areas within the State, including the northern, central, and southern portions of the State.

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Carol Murphy (D)*, 

Introduced, Referred to Assembly Financial Institutions and Insurance Committee (on 11/16/2020)