An Act to Prohibit
Maine Legislature, Session 132, LD 1800
Committee Amendment CA_A_H546 (House)
Amends: 24 MRSA §2317-B, 24-A MRSA §2770-A, 24-A MRSA §2847-X, 24-A MRSA §4261

COMMITTEE AMENDMENT " A " to H,P. 1205, L.D. 1800, "An Act to Prohibit
Health Care Entities Providing Dental Plans from Requiring Dentists to Charge Fees for
Uncovered Services"
Amend the bill by striking out the title and substituting the following;
'An Act to Prohibit Health Care Entities Providing Dental Plans from Requnting.^a
Dental Provider to Charge Fees for Uncovered Dental Services'
Amend the bill by striking out everything after the enacting clause and inserting; the
following;
'See. 1. 24 MRSA §2317-B, sub-§12-I is enacted to read; . - , _:..A : .^,.L^.
IS ""• 12-1. Title 24-A. sections 2770-A, 2847-X and 4261. Fees for covered derital^are
sei-vices. Title 24-A. sections 2770-A.2847.Xand 4261; " ••*•'•' -^-.*-.'.'..•
Sec. 2. 24-A MRSA §2770-A is enacted to read;
82770-A. Fees for covered dental services
1. Definitions. As used in this section, unless the context otherwise indicates, the
followme terms have the followinK meanings,
A. ^^ "^ dental service" means a dental service for which reimbursement js
available under an insurance policy or contract or for which reimbursement would be
available but for the application of contractual limitations such as a deductible,
copayment. coinsurance. waitinp period. annual or lifetime maximum, frequency
limitation, alternative benefit payment or any other similar limitation.
B. "DentaLDi'ovider" means a person licensed under Title 32. chapter 143. subchaoter
1
2< Prohibition of required fees for dental services not covered. An insurer that
issues individual dental insurance or that issues health insurance that covers dental services
may not require, directly or indirectlv, that a participating dental provider provide dental
COMMITTEE AMENDMENT
9-oc> -__.___..__.__..».. ..-._.-._...-
COMMITTEE AMENDMENT "A." to H,P. 1205, L.D, 1800
services at a fee set by. or subject to the ariDrova} of. the insurer for a service that is not a
covered dental service,
3j, _ Fei«.fQr coverecLdental seffices^ A feeA\ a cov be set
_bv the insurer in good faith and may not be nominal,
See. 3. 24-A MRSA §2847-X is enacted to read:
§^847"X. Fees for covered dental services
1. Definitions, As used in this section, unless the context otherwise indicates, the
folIowinE terms have the following meanines.
A, "Covered dental service" means a dental service for _which .reimbursement is
available under an insurance policy or contract or for which feunbursement.wouid be
available butfQr the application of contractual litnjta.tioiis such as & deductible,
cooavment. coinsurance, waitine period, annual or lifetime maximum, freauencv
limitation, alternative benefit Ravment or any other similar limitatie!L.
B. "Dental m'ovider" means a oerson licensed imderTitie 32. chapter 143. subohaBtei'
3_
2. Prohibition of required fees for dental services not covered. An insurer that
issues group dental insurance or that issues group health insurance that covers dental
services may not require, directly or indirectly, that aDartlohating dental provider Drovjde
dental services at a fee set by. or subject to the aoDroval of, the insurer for a service that is
not a covered dental service.
3. Fees for covered dental services. A fee for a covered dental seryice must be- set
by the insurer iu eood faith and may not be nominal,
Sec. 4. 24-A MRSA §4261 is enacted to read;
§4261. Fees for CQvet'ed dental services
1. Definitions. As used in this section, unless the context otherwise mdicates. the
fo Elowin e terms have the foUowinfi meaninps.
A. "Covered dental set-vice" means a dental service for which reimbursement Is
availableugder an individual or eroup contract or for which reimbursement would be
available but for the aooUcation of contractual limitations such as a deductible.
comvment coinsut'ance. waiting oeriod. annual or lifetime maximum. freguencY
limitation, altemattve benefit payment or any other similar limitation.
2 B. "Dental provider" means a person licensed under Title 32. chapter 143, subchapter
3,
2, Prohibitioa of required fees for dental sei'vjces not covered. A health
maintenanceomamzation that issues individual or KI'OUD dental insufance or individual_or
6 group contracts that include coveraee for dental services may not require, directly or
mdirectly., that a participating dental provider provide dental services at a fee set by,,pr
subject to the aDDfQva} of. the health maintenance oreanization for a service that is not a
covered dental service.
3. FefeS .for covered dental services. A fee for a covered dental seryice must be set
by the health maintenance orKanizatiQn ineoQd faith and may not be nommaV
COMMITTEE AMENDMENT
COMMITTEE AMENDMENT "&-» to H.P. 1205, L.D,1800
Amend the bill by relettering or renumbering any nonconsecutive Part letter or section
number to read consecutively,
SUMMARY
This amendment makes technical changes to die bill and changes the title. The
amendment applies the substantive provisions of the bill to health maintenance
organizations in the appropriate chapter of the Maine Insurance Code.
COMMITTEE AMENDMENT