Substitute Senate Bill No. 838
Public Act No. 19-201
AN ACT CONCERNING VI SION PLANS, OPTOMETR ISTS 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 Section 38a-472h of the general statutes is repealed and
the following is substituted in lieu thereof (Effective January 1, 2020):
(a) No insurer, health care center, fraternal benefit society, hospital
service corporation, medical service corporation or other entity
delivering, issuing for delivery, renewing, amending or continuing:
(1) An individual or a group dental plan in this state shall include in
any contract with a dentist licensed pursuant to chapter 379 that is
entered into, renewed or amended on or after January 1, 2012, any
provision that requires such dentist to accept as payment an amount
set by such insurer, center, society, corporation or entity for services or
procedures provided to an insured or enrollee that are not covered
benefits under such insured's or enrollee's plan; or
(2) An individual or a group vision plan in this state shall include in
any contract with an optometrist licensed pursuant to chapter 380 or
an ophthalmologist licensed pursuant to chapter 370 that is entered
into, renewed or amended on or after January 1, [2016] 2020, any
provision that requires such optometrist or ophthalmologist to accept Substitute Senate Bill No. 838
Public Act No. 19-201 2 of 3
as payment an amount set by such insurer, center, society, corporation
or entity for services, [or] procedures or products provided to an
insured or enrollee that are not covered benefits under such insured's
or enrollee's plan.
(b) No dentist [or optometrist] shall charge more for services or
procedures that are not covered benefits than such dentist's [or
optometrist's] usual and customary rate for such services or
procedures, and no optometrist or ophthalmologist shall charge more
for services, procedures or products that are not covered benefits than
such optometrist's or ophthalmologist's usual and customary rate for
such services, procedures or products.
(c) (1) Each evidence of coverage for an individual or a group dental
plan shall include the following statement:
"IMPORTANT: If you opt to receive dental services or procedures
that are not covered benefits under this plan, a participating dental
provider may charge you his or her usual and customary rate for such
services or procedures. Prior to providing you with dental services or
procedures that are not covered benefits, the dental provider should
provide you with a treatment plan that includes each anticipated
service or procedure to be provided and the estimated cost of each
such service or procedure. To fully understand your coverage, you
may wish to review your evidence of coverage document."
(2) Each evidence of coverage for an individual or a group vision
plan shall include the following statement:
"IMPORTANT: If you opt to receive optometric or ophthalmologic
services, [or] procedures or products that are not covered benefits
under this plan, a participating optometrist or ophthalmologist may
charge you his or her usual and customary rate for such services, [or]
procedures or products. Prior to providing you with optometric or Substitute Senate Bill No. 838
Public Act No. 19-201 3 of 3
ophthalmologic services, [or] procedures or products that are not
covered benefits, the optometrist or ophthalmologist should provide
you with a treatment plan that includes each anticipated service, [or]
procedure or product to be provided and the estimated cost of each
such service, [or] procedure or product. To fully understand your
coverage, you may wish to review your evidence of coverage
document."
(d) Each dentist, [and] optometrist and ophthalmologist shall post,
in a conspicuous place, a notice stating that services, [or] procedures or
products, as applicable, that are not covered benefits under an
insurance policy or plan might not be offered at a discounted rate.
(e) The provisions of this section shall not apply to:
(1) [a] A self-insured plan that covers (A) dental services or
procedures, or (B) optometric or ophthalmologic services, [or]
procedures or products;
(2) [a] A contract that is incorporated in or derived from a collective
bargaining agreement or in which some or all of the material terms are
subject to a collective bargaining process; [.]
(3) A contract that is derived from a multiemployer plan, as defined
in Section 3 of the Employee Retirement Income Security Act of 1974,
as amended from time to time; or
(4) A network of ophthalmologists or optometrists, or both, when
servicing a plan or contract described in subdivision (1), (2) or (3) of
this subsection.