I 
113TH CONGRESS 
1ST SESSION H. R. 1798 
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, 2013 
Mr. GOSAR (for himself, Mr. SIMPSON, Mr. ANDREWS, and Mr. LOEBSACK) 
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 trans-
parency for dental benefits under group health plans. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Dental Insurance Fair-
ness Act of 2013’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
VerDate Mar 15 2010 
23:14 May 01, 2013
Jkt 029200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H1798.IH
H1798
tkelley on DSK3SPTVN1PROD with BILLS
(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 den-
tal insurance industry with windfall profits. 
(3) The Dental Insurance Fairness Act of 2013 
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 (29 
U.S.C. 1185 et seq.) 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 self-insured group health plans insofar as 
they provide dental benefits (including, notwithstanding 
section 732(c)(1), self-insured limited scope dental bene-
fits (described in section 733(c)(2))). 
‘‘(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 re-
quirements: 
VerDate Mar 15 2010 
23:14 May 01, 2013
Jkt 029200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H1798.IH
H1798
tkelley on DSK3SPTVN1PROD with BILLS
‘‘(1) UNIFORM COORDINATION OF BENEFITS.— 
The plan shall provide for coordination of benefits in 
a manner so that the plan pays the same amount re-
gardless of other coverage for such benefits so long 
as the total amount paid does not exceed 100 per-
cent of the amount of the applicable claim. Such co-
ordination shall be effected consistent with such 
rules as the Secretary establishes, based upon simi-
lar model regulations developed by the National As-
sociation 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 ben-
eficiary to designate payment of dental benefits to a 
provider who is not participating in the network.’’. 
Æ 
VerDate Mar 15 2010 
23:14 May 01, 2013
Jkt 029200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6301
E:\BILLS\H1798.IH
H1798
tkelley on DSK3SPTVN1PROD with BILLS