An Act To Guarantee Basic Preventive Dental Health Services for Children in Maine
Maine Legislature, Session 125, LD 1666
Committee: Insurance and Financial Services
Sponsors: KATZ, TREAT, BLODGETT, CUSHING
Amends: 24 MRSA §2317-B, 24-A MRSA §2769, 24-A MRSA §2847-U, 24-A MRSA §4260

Legislative Document 
No. 1666 
S.P. 565 
In Senate, December 21, 2011 
An Act To Guarantee Basic Preventive Dental Health Services for 
Children in Maine 
Approved for introduction by a majority of the Legislative Council pursuant to Joint Rule 
203. 
Received by the Secretary of the Senate on December 19, 2011.  Referred to the Committee 
on Insurance and Financial Services pursuant to Joint Rule 308.2 and ordered printed pursuant 
to Joint Rule 218. 
JOSEPH G. CARLETON, JR. 
Secretary of the Senate 
Presented by Senator KATZ of Kennebec. 
Cosponsored by Representative TREAT of Hallowell and 
Representatives: BLODGETT of Augusta, CUSHING of Hampden. 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1.  24 MRSA §2317-B, sub-§12-I is enacted to read: 
12-I.  Title 24-A, sections 2769 and 2847-U.  Coverage for preventive dental health 
services for enrollees who are one year of age or older and under 18 years of age, Title 
24-A, sections 2769 and 2847-U; 
Sec. 2.  24-A MRSA §2769 is enacted to read: 
§2769.  Coverage for preventive dental health services 
1.  Definitions.  As used in this section, unless the context otherwise indicates, the 
following terms have the following meanings. 
A.  "Preventive dental health services" means: 
(1)  For an enrollee who is one year of age or older and under 18 years of age, 
professionally applied topical fluoride treatments twice annually; 
(2)  For an enrollee who is under 4 years of age and who has active dental 
disease, professionally applied topical fluoride treatments up to 4 times annually; 
and 
(3)  For an enrollee who is one year of age or older and under 18 years of age and 
who has active dental disease and is undergoing orthodontic therapy, 
professionally applied topical fluoride treatments up to 4 times annually. 
2.  Required coverage.  An insurer that issues individual dental insurance or health 
insurance that includes coverage for dental services shall provide coverage for preventive 
dental health services.  
3.  Limits; coinsurance; deductibles.  A contract that provides coverage for the 
services required by this section may contain provisions for maximum benefits and 
coinsurance and reasonable limitations, deductibles and exclusions to the extent that these 
provisions are not inconsistent with the requirements of this section. 
4.  Coordination of benefits with dental insurance.  If an enrollee eligible for 
coverage under this section is eligible for coverage under a dental insurance policy or 
contract and a health insurance policy or contract, the insurer providing dental insurance 
is the primary payer responsible for charges under subsection 2 and the insurer providing 
individual health insurance is the secondary payer. 
5.  Application.  The requirements of this section apply to all policies, contracts and 
certificates executed, delivered, issued for delivery, continued or renewed in this State on 
or after January 1, 2013.  For purposes of this section, all contracts are deemed to be 
renewed no later than the next yearly anniversary of the contract date. 
Sec. 3.  24-A MRSA §2847-U is enacted to read: 
§2847-U.  Coverage for preventive dental health services 
1.  Definitions.  As used in this section, unless the context otherwise indicates, the 
following terms have the following meanings. 
A.  "Preventive dental health services" means: 
(1)  For an enrollee who is one year of age or older and under 18 years of age, 
professionally applied topical fluoride treatments twice annually; 
(2)  For an enrollee who is under 4 years of age and who has active dental 
disease, professionally applied topical fluoride treatments up to 4 times annually; 
and 
(3)  For an enrollee who is one year of age or older and under 18 years of age and 
who has active dental disease and is undergoing orthodontic therapy, 
professionally applied topical fluoride treatments up to 4 times annually. 
2.  Required coverage.  An insurer that issues group dental insurance or health 
insurance that includes coverage for dental services shall provide coverage for preventive 
dental health services. 
3.  Limits; coinsurance; deductibles.  A contract that provides coverage for the 
services required by this section may contain provisions for maximum benefits and 
coinsurance and reasonable limitations, deductibles and exclusions to the extent that these 
provisions are not inconsistent with the requirements of this section. 
4.  Coordination of benefits with dental insurance.  If an enrollee eligible for 
coverage under this section is eligible for coverage under a dental insurance policy or 
contract and a health insurance policy or contract, the insurer providing dental insurance 
is the primary payer responsible for charges under subsection 2 and the insurer providing 
group health insurance is the secondary payer. 
5.  Application.  The requirements of this section apply to all policies, contracts and 
certificates executed, delivered, issued for delivery, continued or renewed in this State on 
or after January 1, 2013.  For purposes of this section, all contracts are deemed to be 
renewed no later than the next yearly anniversary of the contract date. 
Sec. 4.  24-A MRSA §4260 is enacted to read: 
§4260.  Coverage for preventive dental health services 
1.  Definitions.  As used in this section, unless the context otherwise indicates, the 
following terms have the following meanings. 
A.  "Preventive dental health services" means: 
(1)  For an enrollee who is one year of age or older and under 18 years of age, 
professionally applied topical fluoride treatments twice annually; 
(2)  For an enrollee who is under 4 years of age and who has active dental 
disease, professionally applied topical fluoride treatments up to 4 times annually; 
and 
(3)  For an enrollee who is one year of age or older and under 18 years of age, 
who has active dental disease and is undergoing orthodontic therapy, 
professionally applied topical fluoride treatments up to 4 times annually. 
2.  Required coverage.  All individual and group health maintenance organization 
contracts that include coverage for dental services shall provide coverage for preventive 
dental health services. 
3.  Limits; coinsurance; deductibles.  A contract that provides coverage for the 
services required by this section may contain provisions for maximum benefits and 
coinsurance and reasonable limitations, deductibles and exclusions to the extent that these 
provisions are not inconsistent with the requirements of this section. 
4.  Coordination of benefits with dental insurance.  If an enrollee eligible for 
coverage under this section is eligible for coverage under a dental insurance policy or 
contract and a health maintenance organization policy or contract, the insurer providing 
dental insurance is the primary payer responsible for charges under subsection 2 and the 
health maintenance organization providing health coverage is the secondary payer. 
5.  Application.  The requirements of this section apply to all policies, contracts and 
certificates executed, delivered, issued for delivery, continued or renewed in this State on 
or after January 1, 2013.  For purposes of this section, all contracts are deemed to be 
renewed no later than the next yearly anniversary of the contract date. 
SUMMARY 
This bill requires dental insurers and health insurers and health maintenance 
organizations that include coverage for dental services in their policies and contracts to 
provide coverage for preventive dental health services for children.  The bill applies to 
policies and contracts issued or renewed on or after January 1, 2013.