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General Assembly Substitute Bill No. 7173
January Session, 2019
AN ACT CONCERNING CO NTRACTS BETWEEN HEAL TH INSURERS,
OPTOMETRISTS AND OPHTHALMOLOGISTS.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Section 38a-472h of the general statutes is repealed and 1
the following is substituted in lieu thereof (Effective January 1, 2020): 2
(a) No insurer, health care center, fraternal benefit society, hospital 3
service corporation, medical service corporation or other entity 4
delivering, issuing for delivery, renewing, amending or continuing: 5
(1) An individual or a group dental plan in this state shall include in 6
any contract with a dentist licensed pursuant to chapter 379 that is 7
entered into, renewed or amended on or after January 1, 2012, any 8
provision that requires such dentist to accept as payment an amount 9
set by such insurer, center, society, corporation or entity for services or 10
procedures provided to an insured or enrollee that are not covered 11
benefits under such insured's or enrollee's plan; or 12
(2) An individual or a group vision plan in this state shall include in 13
any contract with an optometrist licensed pursuant to chapter 380 or 14
an ophthalmologist licensed pursuant to chapter 370 that is entered 15
into, renewed or amended on or after January 1, [2016] 2020, any 16
provision that requires such optometrist or ophthalmologist to accept 17
as payment an amount set by such insurer, center, society, corporation 18 Substitute Bill No. 7173
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or entity for services, [or] procedures or products provided to an 19
insured or enrollee that are not covered benefits under such insured's 20
or enrollee's plan. 21
(b) No dentist [or optometrist] shall charge more for services or 22
procedures that are not covered benefits than such dentist's [or 23
optometrist's] usual and customary rate for such services or 24
procedures, and no optometrist or ophthalmologist shall charge more 25
for services, procedures or products that are not covered benefits than 26
such optometrist's or ophthalmologist's usual and customary rate for 27
such services, procedures or products. 28
(c) (1) Each evidence of coverage for an individual or a group dental 29
plan shall include the following statement: 30
"IMPORTANT: If you opt to receive dental services or procedures 31
that are not covered benefits under this plan, a participating dental 32
provider may charge you his or her usual and customary rate for such 33
services or procedures. Prior to providing you with dental services or 34
procedures that are not covered benefits, the dental provider should 35
provide you with a treatment plan that includes each anticipated 36
service or procedure to be provided and the estimated cost of each 37
such service or procedure. To fully understand your coverage, you 38
may wish to review your evidence of coverage document." 39
(2) Each evidence of coverage for an individual or a group vision 40
plan shall include the following statement: 41
"IMPORTANT: If you opt to receive optometric or ophthalmologic 42
services, [or] procedures or products that are not covered benefits 43
under this plan, a participating optometrist or ophthalmologist may 44
charge you his or her usual and customary rate for such services, [or] 45
procedures or products. Prior to providing you with optometric or 46
ophthalmologic services, [or] procedures or products that are not 47
covered benefits, the optometrist or ophthalmologist should provide 48
you with a treatment plan that includes each anticipated service, [or] 49 Substitute Bill No. 7173
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procedure or product to be provided and the estimated cost of each 50
such service, [or] procedure or product. To fully understand your 51
coverage, you may wish to review your evidence of coverage 52
document." 53
(d) Each dentist, [and] optometrist and ophthalmologist shall post, 54
in a conspicuous place, a notice stating that services, [or] procedures or 55
products, as applicable, that are not covered benefits under an 56
insurance policy or plan might not be offered at a discounted rate. 57
(e) The provisions of this section shall not apply to: 58
(1) [a] A self-insured plan that covers (A) dental services or 59
procedures, or (B) optometric or ophthalmologic services, procedures 60
or products; or 61
(2) [a] A contract that is incorporated in or derived from a collective 62
bargaining agreement or in which some or all of the material terms are 63
subject to a collective bargaining process. 64
This act shall take effect as follows and shall amend the following
sections:
Section 1 January 1, 2020 38a-472h
INS Joint Favorable Subst.