HB400INTRODUCED
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HB400
MJDUWW1-1
By Representative Rigsby
RFD: Insurance
First Read: 06-Mar-25
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5 MJDUWW1-1 02/19/2025 JC (L)lg 2024-3195
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First Read: 06-Mar-25
SYNOPSIS:
Under current practice, an insurance policy
covering dental care may limit the available maximum
dollar amount of benefits for use to the year that the
policy is in effect.
This bill would require insurers that provide
dental coverage in the State of Alabama to allow
covered beneficiaries to roll over unused benefits into
subsequent years, within certain conditions.
A BILL
TO BE ENTITLED
AN ACT
Relating to dental insurance; to require contracts for
dental care coverage to provide that a beneficiary may carry
over an unused amount of available benefits into the
succeeding year; to set conditions on the right to carry over
available benefits; and to amend Sections 10A-20-6.16 and
27-21A-23, Code of Alabama 1975, to make conforming changes.
BE IT ENACTED BY THE LEGISLATURE OF ALABAMA:
Section 1. (a) For the purposes of this section, the
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Section 1. (a) For the purposes of this section, the
following terms have the following meanings:
(1) ANNUAL BENEFIT MAXIMUM. The total dollar amount of
dental care services benefits available to an individual
enrolled as a beneficiary under a dental benefit plan or
health benefit plan for a year.
(2) DENTAL BENEFIT PLAN. Any stand-alone individual or
group plan, policy, or contract issued, delivered, or renewed
in this state which is limited to paying or reimbursing the
costs of dental care services.
(3) DENTAL CARE SERVICES. Any services furnished to a
beneficiary for the purpose of preventing, managing,
alleviating, curing, or healing dental illness, disease, or
injury.
(4) HEALTH BENEFIT PLAN. a. Any individual or group
plan, policy, or contract issued, delivered, or renewed in
this state which, in addition to paying or reimbursing for
hospitalization, physician care, treatment, surgery, therapy,
drugs, equipment, and other medical expenses, also includes
coverage for some dental care services.
b. The term does not include accident-only, specified
disease, individual hospital indemnity, credit, Medicare
supplement, long-term care, disability income, or other
limited benefit health insurance policies, or coverage issued
as supplemental to liability insurance, workers' compensation,
or automobile medical payment insurance.
(5) INSURER. A person as defined in Section 27-1-2,
Code of Alabama 1975, that issues, delivers, or renews a
dental benefit plan or a health benefit plan.
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dental benefit plan or a health benefit plan.
(6) UNSPENT ANNUAL BENEFIT MAXIMUM DOLLARS. The portion
of an annual benefit maximum that was not paid out or
reimbursed on claims for a beneficiary during a year.
(7) YEAR. A calendar year or other 12-month period that
a dental benefit plan or health care plan is in effect.
(b) On or after January 1, 2026, any insurer that
issues, delivers, or renews a dental benefit plan or a health
benefit plan shall include a provision that allows a
beneficiary to carry over the amount of unspent annual benefit
maximum dollars into the succeeding year for payment or
reimbursement of dental care services.
(c) The unspent annual benefit maximum dollars carried
over shall be added to the annual benefit maximum for the
succeeding year as limited by subdivision (e)(2).
(d) Claims incurred during the current year but not
paid until the succeeding year shall be subtracted from the
current year annual benefit maximum.
(e)(1) An insurer may in its discretion prescribe
terms, limitations, and conditions governing the exercise by
the beneficiary of the contractual provision required under
subsection (b), but shall require the limitation described in
subdivision (2).
(2) The aggregate dollar amount that may be accumulated
by a covered individual to carry over is limited to two times
the annual benefit maximum that is in effect for the preceding
year.
(f) The Department of Insurance of the State of Alabama
may adopt rules necessary to implement this section.
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may adopt rules necessary to implement this section.
Section 2. Sections 10A-20-6.16 and 27-21A-23, Code of
Alabama 1975, are amended to read as follows:
"§10A-20-6.16
(a) No statute of this state applying to insurance
companies shall be applicable to any corporation organized
under this article and amendments thereto or to any contract
made by the corporation; except the corporation shall be
subject to the following:
(1) The provisions regarding annual premium tax to be
paid by insurers on insurance premiums.
(2) Chapter 55 of Title 27.
(3) Article 2 and Article 3 of Chapter 19 of Title 27.
(4) Section 27-1-17.
(5) Chapter 56 of Title 27.
(6) Rules adopted by the Commissioner of Insurance
pursuant to Sections 27-7-43 and 27-7-44.
(7) Chapter 54 of Title 27.
(8) Chapter 57 of Title 27.
(9) Chapter 58 of Title 27.
(10) Chapter 59 of Title 27.
(11) Chapter 54A of Title 27.
(12) Chapter 12A of Title 27.
(13) Chapter 2B of Title 27.
(14) Chapter 29 of Title 27.
(15) Chapter 62 of Title 27.
(16) Chapter 63 of Title 27.
(17) Chapter 45A of Title 27.
(18) Section 1 of the act amending this section.
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(18) Section 1 of the act amending this section.
(b) The provisions in subsection (a) that require
specific types of coverage to be offered or provided shall not
apply when the corporation is administering a self-funded
benefit plan or similar plan, fund, or program that it does
not insure."
"§27-21A-23
(a) Except as otherwise provided in this chapter,
provisions of the insurance law and provisions of health care
service plan laws shall not be applicable to any health
maintenance organization granted a certificate of authority
under this chapter. This provision shall not apply to an
insurer or health care service plan licensed and regulated
pursuant to the insurance law or the health care service plan
laws of this state except with respect to its health
maintenance organization activities authorized and regulated
pursuant to this chapter.
(b) Solicitation of enrollees by a health maintenance
organization granted a certificate of authority shall not be
construed to violate any provision of law relating to
solicitation or advertising by health professionals.
(c) Any health maintenance organization authorized
under this chapter shall not be deemed to be practicing
medicine and shall be exempt from the provisions of Section
34-24-310, et seq., relating to the practice of medicine.
(d) No person participating in the arrangements of a
health maintenance organization other than the actual provider
of health care services or supplies directly to enrollees and
their families shall be liable for negligence, misfeasance,
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their families shall be liable for negligence, misfeasance,
nonfeasance, or malpractice in connection with the furnishing
of such services and supplies.
(e) Nothing in this chapter shall be construed in any
way to repeal or conflict with any provision of the
certificate of need law.
(f) Notwithstanding the provisions of subsection (a), a
health maintenance organization shall be subject to all of the
following:
(1) Section 27-1-17.
(2) Chapter 56.
(3) Chapter 54.
(4) Chapter 57.
(5) Chapter 58.
(6) Chapter 59.
(7) Rules adopted by the Commissioner of Insurance
pursuant to Sections 27-7-43 and 27-7-44.
(8) Chapter 12A.
(9) Chapter 54A.
(10) Chapter 2B.
(11) Chapter 29.
(12) Chapter 62.
(13) Chapter 63.
(14) Chapter 45A
(15) Section 1 of the act amending this section ."
Section 3. This act shall become effective on October
1, 2025.
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