An Act Regarding Insurance Coverage of Certain Dental Services
Maine Legislature, Session 128, LD 0900
Committee Amendment CA_A_S56 (Senate)
Amends: 24-A MRSA §2770, 24-A MRSA §2847-V, 24-A MRSA §4260

COMMITTEE AMENDMENT" A "to S.P. 302, L.D. 900, Bill, "An Act Regarding 
Insurance Coverage of Certain Dental Services" 
Amend the bill by striking out all of sections 2 to 5 and inserting the following: 
'Sec. 2. 24-A MRSA §2770 is enacted to read: 
§2770. Limits on fees for dental services 
1. Definitions. As used in this section, unless the context otherwise indicates, the 
following terms have the following meanings. 
A. 
"Covered service" means a dental care service for which reimbursement is 
available under an enrollee's plan contract or for which reimbursement would be 
available but for the application of contractual limitations such as deductibles, 
copayments, coinsurance, waiting periods, annual or lifetime maximums, frequency 
limitations, alternative benefit payments or any other limitation. 
B. "Dental provider" means a dentist, independent practice dental hygienist or dental 
hygiene therapist licensed under Title 32, chapter 143 who is providing dental 
services within the lawful scope of practice of the dentist, independent practice dental 
hygienist or dental hygiene therapist. 
C. 
"Enrollee" means an individual who is covered under an individual health 
insurance contract provided by an insurer. 
2. Limits on fees. An insurer that issues individual dental insurance or health 
insurance that includes coverage for dental services may not restrict, limit or otherwise 
control a fee that a dental provider charges an enrollee for a service unless the service is a 
covered service under the patient's policy or contract. 
Sec. 3. 24-A MRSA §2847-V is enacted to read: 
COMMITTEE AMENDMENT 
A. m S. 
COMMITIEE AMENDMENT" A" to S.P. 302, L.D. 900 
§2847-V. Limits on fees for dental services 
1. Definitions. As used in this section, unless the context otherwise indicates, the 
following terms have the following meanings. 
A. 
"Covered service" means a dental care service for which reimbursement is 
available under an enrollee's plan contract or for which reimbursement would be 
available but for the application of contractual limitations such as deductibles. 
copayments. coinsurance, waiting periods, annual or lifetime maximums, frequency 
limitations, alternative benefit payments or any other limitation. 
B. "Dental provider" means a dentist, independent practice dental hygienist or dental 
hygiene therapist licensed under Title 32, chapter 143 who is providing dental 
services within the lawful scope of practice of the dentist, independent practice dental 
hygienist or dental hygiene therapist. 
C. "Enrollee" means an individual who is covered under a group health insurance 
contract provided by an insurer. 
2. Limits on fees. An insurer that issues group dental insurance or health insurance 
that includes coverage for dental services may not restrict, limit or otherwise control a fee 
that a dental provider charges an enrollee for a service unless the service is a covered 
service under the patient's policy or contract. 
Sec. 4. 24-A MRSA §4260 is enacted to read: 
§4260. Limits on fees for dental services 
1. Definitions. As used in this section, unless the context otherwise indicates, the 
following terms have the following meanings. 
A. 
"Covered service" means a dental care service for which reimbursement is 
available under an enrollee's plan contract or for which reimbursement would be 
available but for the application of contractual limitations such as deductibles, 
copayments, coinsurance, waiting periods, annual or lifetime maximums, frequency 
limitations, alternative benefit payments or any other limitation. 
B. "Dental provider" means a dentist, independent practice dental hygienist or dental 
hygiene therapist licensed under Title 32, chapter 143 who is providing dental 
services within the lawful scope of practice of the dentist, independent practice dental 
hygienist or dental hygiene therapist. 
C. "Enrollee" means an individual who is covered under an individual or group 
health maintenance organization contract. 
2. Limits on fees. An individual or group health maintenance organization contract 
that includes coverage for dental services may not restrict, limit or otherwise control a fee 
that a dental provider charges an enrollee for a service unless the service is a covered 
service under the patient's policy or contract. 
Sec. 5. Application. The requirements of this Act apply to contracts between a 
dental provider, as defined in the Maine Revised Statutes, Title 24-A, sections 2770, 
2847-V and 4260, and an insurer or health maintenance organization that issues 
COMMITTEE AMENDMENT 
A. of S. 
COMMITIEE AMENDMENT "A "to S.P. 302, L.D. 900 
individual or group coverage for dental services executed or renewed on or after January 
1, 2018.' 
SUMMARY 
This amendment is the minority report of the committee and replaces most of the bill. 
Like the bill, the amendment prohibits insurers and health maintenance organizations 
offering individual and group coverage from limiting dental fees that are not covered by 
the insurer. The amendment also adds a definition of "covered service" to clarify that a 
dental provider must charge the contracted fee for a service that a health plan or dental 
plan would be obligated to pay but for the application of contractual limitations such as 
deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums, 
frequency limitations, alternative benefit payments or any other limitations. 
The amendment changes the term "dentist" to "dental provider" with the intent to 
include independent practice dental hygienists and dental hygiene therapists as well as 
dentists. 
The amendment also eliminates references in the bill that appear to permit balance 
billing of a patient. 
The amendment applies to contracts executed or renewed on or after January 1, 2018. 
COMMITTEE AMENDMENT