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[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4818 Introduced in House (IH)]

112th CONGRESS
  2d Session
                                H. R. 4818

To amend the Employee Retirement Income Security Act of 1974 to ensure 
 health care coverage value and transparency for dental benefits under 
                          group health plans.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                             April 26, 2012

  Mr. Gosar introduced the following bill; which was referred to the 
                Committee on Education and the Workforce

_______________________________________________________________________

                                 A BILL

 
To amend the Employee Retirement Income Security Act of 1974 to ensure 
 health care coverage value and transparency for dental benefits under 
                          group health plans.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Dental Insurance Fairness Act of 
2012''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Dental coverage helps approximately 173 million 
        Americans get the dental care that is vital to ensuring good 
        oral and overall health.
            (2) Unfair practices of dental benefit plans hinder 
        patients' ability to receive the full benefits for which they 
        pay and, in some cases, provide the dental insurance industry 
        with windfall profits.
            (3) The Dental Insurance Fairness Act of 2012 will help 
        consumers receive the full value of their dental coverage.

SEC. 3. VALUE REQUIREMENTS FOR DENTAL BENEFITS.

    Subpart B of part 7 of subtitle B of title I of the Employee 
Retirement Income Security Act of 1974 is amended by adding at the end 
the following:

``SEC. 716. VALUE REQUIREMENTS FOR DENTAL BENEFITS.

    ``(a) In General.--The requirements of this section shall apply to 
group health plans insofar as they provide dental benefits (including, 
notwithstanding section 732(c)(1), limited scope dental benefits 
(described in section 733(c)(2))), directly, through health insurance 
coverage, or otherwise.
    ``(b) Value.--In order to ensure that participants and 
beneficiaries in a group health plan receive full value from dental 
benefits, the plan shall meet the following requirements:
            ``(1) Uniform coordination of benefits.--The plan shall 
        provide for coordination of benefits in a manner so that the 
        plan pays the same amount regardless of other coverage for such 
        benefits so long as the total amount paid does not exceed 100 
        percent of the amount of the applicable claim. Such 
        coordination shall be effected consistent with such rules as 
        the Secretary establishes, based upon similar model regulations 
        developed by the National Association of Insurance 
        commissioners.
            ``(2) Equity for dental patients through assignment of 
        benefits.--In the case of a plan that provides dental benefits 
        through a network of providers, the plan shall permit a 
        participant or beneficiary to designate payment of dental 
        benefits to a provider who is not participating in the 
        network.''.
                                 <all>
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