*SB0136.1*
January 13, 2022
SENATE BILL No. 136
_____
DIGEST OF SB 136 (Updated January 12, 2022 2:43 pm - DI 55)
Citations Affected: IC 27-7.
Synopsis: Dental plans and access to dental networks. Prohibits a
dental plan (an insurance policy, a health maintenance organization
contract, or a preferred provider plan) from directly or indirectly
requiring a dental provider to provide a dental service to a covered
individual at a fee amount that is: (1) set by the dental plan; or (2)
subject to the approval of the dental plan; unless the dental service is
a covered service under the dental plan. Provides that a dental plan
violates this prohibition by requiring a dental provider to provide a
dental service to a covered individual at a fee amount set by the dental
plan or subject to the dental plan's approval even if the dental service
is a covered service if the coverage of the dental service is merely
nominal or de minimis coverage. Prohibits a third party administrator
or another person from arranging for a dental provider to provide dental
services for a dental plan that sets the amount of the fee for any dental
services unless the dental services are covered services under the
dental plan. Provides that a contracting entity (a dental carrier, a third
party administrator, or another person that enters into a provider
network contract with providers of dental services) may not grant a
third party access to the provider network contract or to dental services
or contractual discounts provided pursuant to the provider network
(Continued next page)
Effective: July 1, 2022.
Zay, Doriot, Koch
January 4, 2022, read first time and referred to Committee on Insurance and Financial
Institutions.
January 12, 2022, amended, reported favorably — Do Pass.
SB 136—LS 6590/DI 55 Digest Continued
contract unless certain conditions are satisfied. Provides that when a
provider network contract is entered into or renewed, or when there are
material modifications to a provider network contract, any dental
service provider that is a party to the provider network contract must
be allowed to choose not to participate in the third party access.
Prohibits a contracting entity from: (1) altering the rights or status
under a provider network contract of a provider that chooses not to
participate in third party access; or (2) rejecting a provider as a party
to a provider network contract because the provider chose not to
participate in third party access. Authorizes the insurance
commissioner to issue a cease and desist order against a person that
violates any of these prohibitions and, if the person violates the cease
and desist order, to impose a civil penalty upon the person and suspend
or revoke the person's certificate of authority.
SB 136—LS 6590/DI 55SB 136—LS 6590/DI 55 January 13, 2022
Second Regular Session of the 122nd General Assembly (2022)
PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
Constitution) is being amended, the text of the existing provision will appear in this style type,
additions will appear in this style type, and deletions will appear in this style type.
Additions: Whenever a new statutory provision is being enacted (or a new constitutional
provision adopted), the text of the new provision will appear in this style type. Also, the
word NEW will appear in that style type in the introductory clause of each SECTION that adds
a new provision to the Indiana Code or the Indiana Constitution.
Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
between statutes enacted by the 2021 Regular Session of the General Assembly.
SENATE BILL No. 136
A BILL FOR AN ACT to amend the Indiana Code concerning
insurance.
Be it enacted by the General Assembly of the State of Indiana:
1 SECTION 1. IC 27-7-17 IS ADDED TO THE INDIANA CODE AS
2 A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE JULY
3 1, 2022]:
4 Chapter 17. Dental Plans Setting Fees for Dental Services
5 Sec. 1. As used in this chapter, "covered individual" means an
6 individual who is entitled to:
7 (1) dental services; or
8 (2) coverage of dental services.
9 Sec. 2. As used in this chapter, "covered service" means a dental
10 service for which a reimbursement:
11 (1) is available under a dental plan; or
12 (2) would be available under a dental plan but for the
13 application of contractual limitations such as:
14 (A) deductibles;
15 (B) copayments;
16 (C) coinsurance;
17 (D) waiting periods;
SB 136—LS 6590/DI 55 2
1 (E) annual or lifetime maximums;
2 (F) frequency limitations;
3 (G) alternative benefit payments; or
4 (H) any other limitation;
5 under the dental plan.
6 Sec. 3. (a) As used in this chapter, "dental plan" means any of
7 the following:
8 (1) A policy issued by an insurer (as defined in IC 27-1-2-3(x))
9 that provides coverage for dental services.
10 (2) A contract under which a health maintenance organization
11 (as defined in IC 27-13-1-19) provides or covers dental
12 services.
13 (3) A preferred provider plan (as defined in IC 27-8-11-1(g))
14 that provides or covers dental services.
15 (b) The term does not include the following:
16 (1) A policy providing comprehensive coverage described in
17 Class 1(b) and Class 2(a) of IC 27-1-5-1.
18 (2) Accident only, Medicare supplement, long term care, or
19 disability income insurance.
20 (3) Coverage issued as a supplement to liability insurance.
21 (4) Automobile medical payment insurance.
22 (5) A specified disease policy.
23 (6) Worker's compensation or similar insurance.
24 (7) A student health plan.
25 (8) A supplemental plan that always pays in addition to other
26 coverage.
27 Sec. 4. As used in this chapter, "dental service" means any
28 service provided by a dentist within the scope of the dentist's
29 licensure under IC 25-14.
30 Sec. 5. As used in this chapter, "person" means an individual, a
31 corporation, a limited liability company, a partnership, or any
32 other legal entity.
33 Sec. 6. As used in this chapter, "provider" means:
34 (1) a dentist licensed under IC 25-14; or
35 (2) a dental office through which one (1) or more dentists
36 licensed under IC 25-14 provide dental services.
37 Sec. 7. (a) A dental plan may not directly or indirectly require
38 a provider to provide a dental service to a covered individual at a
39 fee amount that is:
40 (1) set by the dental plan; or
41 (2) subject to the approval of the dental plan;
42 unless the dental service is a covered service.
SB 136—LS 6590/DI 55 3
1 (b) A dental plan that requires a provider to provide a dental
2 service to a covered individual at a fee amount that is:
3 (1) set by the dental plan; or
4 (2) subject to the approval of the dental plan;
5 violates subsection (a) even if the dental service is a covered service
6 if the coverage of the dental service under the dental plan is merely
7 nominal or de minimis coverage.
8 Sec. 8. A third party administrator or other person that:
9 (1) is not a dental plan; but
10 (2) arranges for providers to provide dental services through
11 dental plans or through another sort of network
12 arrangement;
13 shall not arrange for a provider to provide dental services for a
14 dental plan that sets the amount of the fee for the dental services
15 unless the dental services are covered services under the dental
16 plan.
17 Sec. 9. (a) If:
18 (1) an insurer (as defined in IC 27-1-2-3(x));
19 (2) a health maintenance organization (as defined in
20 IC 27-13-1-19);
21 (3) a preferred provider plan (as defined in IC 27-8-11-1(g));
22 or
23 (4) any other person;
24 violates this chapter, the insurance commissioner may enter an
25 order requiring the person to cease and desist from violating this
26 chapter.
27 (b) If a person violates a cease and desist order issued under
28 subsection (a), the insurance commissioner, after notice and
29 hearing under IC 4-21.5, may:
30 (1) impose a civil penalty upon the person of not more than
31 ten thousand dollars ($10,000) for each day of violation;
32 (2) suspend or revoke the person's certificate of authority, if
33 the person holds a certificate of authority under this title; or
34 (3) both impose a civil penalty upon the person under
35 subdivision (1) and suspend or revoke the person's certificate
36 of authority under subdivision (2).
37 SECTION 2. IC 27-7-18 IS ADDED TO THE INDIANA CODE AS
38 A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE JULY
39 1, 2022]:
40 Chapter 18. Third Party Access to Dental Provider Networks
41 Sec. 1. As used in this chapter, "contracting entity" means a
42 dental carrier, a third party administrator, or another person that
SB 136—LS 6590/DI 55 4
1 enters into a provider network contract with providers for the
2 delivery of dental services in the ordinary course of business.
3 Sec. 2. As used in this chapter, "covered individual" means an
4 individual who is entitled to:
5 (1) dental services; or
6 (2) coverage of dental services;
7 through a provider network contract.
8 Sec. 3. As used in this chapter, "dental carrier" means any of
9 the following:
10 (1) An insurer that issues a policy of accident and sickness
11 insurance that covers dental services.
12 (2) A health maintenance organization that provides, or
13 provides coverage for, dental services.
14 (3) An entity that:
15 (A) provides dental services; or
16 (B) arranges for dental services to be provided;
17 but is not itself a provider.
18 Sec. 4. (a) As used in this chapter, "dental service" means any
19 service provided by a dentist within the scope of the dentist's
20 licensure under IC 25-14.
21 (b) The term does not include a service delivered by a provider
22 that is billed as a medical expense.
23 Sec. 5. As used in this chapter, "health insurer" means:
24 (1) an insurer that issues policies of accident and sickness
25 insurance (as defined in IC 27-8-5-1); or
26 (2) a health maintenance organization (as defined in
27 IC 27-13-1-19).
28 Sec. 6. As used in this chapter, "person" means an individual, a
29 corporation, a limited liability company, a partnership, or any
30 other legal entity.
31 Sec. 7. (a) As used in this chapter, "provider" means:
32 (1) a dentist licensed under IC 25-14; or
33 (2) a dental office through which one (1) or more dentists
34 licensed under IC 25-14 provide dental services.
35 (b) The term does not include a physician organization or
36 physician hospital organization that leases or rents the network of
37 the physician organization or physician hospital organization
38 network to a third party.
39 Sec. 8. As used in this chapter, "provider network contract"
40 means a contract between a contracting entity and one (1) or more
41 providers:
42 (1) that establishes a network through which the providers:
SB 136—LS 6590/DI 55 5
1 (A) provide dental services to covered individuals; and
2 (B) are compensated for providing the dental services; and
3 (2) that specifies the rights and responsibilities of the
4 contracting entity and the providers concerning the network.
5 Sec. 9. (a) As used in this chapter, "third party" means a person
6 that enters into a contract with a contracting entity or another
7 third party to gain access to:
8 (1) a provider network contract;
9 (2) dental services provided pursuant to a provider network
10 contract; or
11 (3) contractual discounts provided pursuant to a provider
12 network contract.
13 (b) The term does not include an employer or another group or
14 entity for which the contracting entity provides administrative
15 services.
16 Sec. 10. (a) This section applies if a contracting entity seeks to
17 grant a third party access to:
18 (1) a provider network contract;
19 (2) dental services provided pursuant to a provider network
20 contract; or
21 (3) contractual discounts provided pursuant to a provider
22 network contract.
23 (b) Except as provided in subsection (c) and section 16 of this
24 chapter, in order for a contracting entity to grant a third party
25 access as described in subsection (a), the following conditions must
26 be satisfied:
27 (1) When a provider network contract is entered into or
28 renewed, or when there are material modifications to a
29 provider network contract relevant to granting access to a
30 third party as described in subsection (a):
31 (A) any provider that is a party to the provider network
32 contract must be allowed to choose not to participate in the
33 third party access as described in subsection (a); or
34 (B) if third party access is to be provided through the
35 acquisition of the provider network by a health insurer,
36 any provider that is a party to the provider network
37 contract must be allowed to enter into a contract directly
38 with the health insurer that acquired the provider
39 network.
40 (2) The provider network contract must specifically authorize
41 the contracting entity to enter into an agreement with third
42 parties allowing the third parties to obtain the contracting
SB 136—LS 6590/DI 55 6
1 entity's rights and responsibilities as if the third party were
2 the contracting entity.
3 (3) If the contracting entity seeking to grant a third party
4 access as described in subsection (a) is a dental carrier, a
5 provider that is a party to the provider network contract must
6 have chosen to participate in third party access at the time the
7 provider network contract was entered into or renewed.
8 (4) If the contracting entity seeking to grant a third party
9 access as described in subsection (a) is a health insurer, the
10 provider network contract must contain a third party access
11 provision specifically granting third party access to the
12 provider network.
13 (5) If the contracting entity seeking to grant a third party
14 access as described in subsection (a) is a dental carrier, the
15 provider network contract must state that the provider has a
16 right to choose not to participate in the third party access.
17 (6) The third party being granted access as described in
18 subsection (a) must agree to comply with all of the terms of
19 the provider network contract.
20 (7) The contracting entity seeking to grant third party access
21 as described in subsection (a) must identify to each provider
22 that is a party to the provider network contract, in writing or
23 electronic form, all third parties in existence as of the date on
24 which the provider network contract is entered into or
25 renewed.
26 (8) The contracting entity granting third party access as
27 described in subsection (a) must identify, in a list on its
28 Internet web site that is updated at least once every ninety
29 (90) days, all third parties to which third party access has
30 been granted.
31 (9) If third party access as described in subsection (a) is to be
32 granted through the sale or leasing of the network established
33 by the provider network contract, the contracting entity must
34 notify all providers that are parties to the provider network
35 contract of the leasing or sale of the network at least thirty
36 (30) days before the sale or lease of the network takes effect.
37 (10) The contracting entity seeking to grant third party access
38 to contractual discounts as described in subsection (a)(3) must
39 require each third party to identify the source of the discount
40 on all remittance advices or explanations of payment under
41 which a discount is taken. However, this subdivision does not
42 apply to electronic transactions mandated by the federal
SB 136—LS 6590/DI 55 7
1 Health Insurance Portability and Accountability Act of 1996
2 (Public Law 104-191).
3 (c) A contracting entity may grant a third party access as
4 described in subsection (a) even if the conditions set forth in
5 subsection (b)(1) are not satisfied if the contracting entity is not a
6 health insurer or a dental carrier.
7 (d) Except as provided in subsection (c) and section 16 of this
8 chapter, a provider that is a party to a provider network contract
9 is not required to provide dental services pursuant to third party
10 access granted as described in subsection (a) unless all of the
11 applicable conditions set forth in subsection (b) are satisfied.
12 Sec. 11. A contracting entity that is a party to a provider
13 network contract with a provider that chooses under section
14 10(b)(1)(A) of this chapter not to participate in third party access
15 shall not alter the provider's rights or status under the provider
16 network contract because of the provider's choice not to
17 participate in third party access.
18 Sec. 12. A contracting entity that is a party to a provider
19 network contract shall notify a third party granted third party
20 access as described in section 10(a) of this chapter of the
21 termination of the provider network contract not more than thirty
22 (30) days after the date of the termination.
23 Sec. 13. The right of a third party to contractual discounts
24 described in section 10(a)(3) of this chapter ceases as of the
25 termination date of the provider network contract.
26 Sec. 14. A contracting entity that is a party to a provider
27 network contract shall make a copy of the provider network
28 contract relied on in the adjudication of a claim available to a
29 participating provider not more than thirty (30) days after the date
30 of the participating provider's request.
31 Sec. 15. When entering into a provider network contract with
32 providers, a contracting entity shall not reject a provider as a
33 party to the provider network contract because the provider
34 chooses or has chosen under section 10(b)(1)(A) of this chapter not
35 to participate in third party access.
36 Sec. 16. (a) Section 10 of this chapter does not apply to access as
37 described in section 10(a) of this chapter if granted by a
38 contracting entity to:
39 (1) a dental carrier or other entity operating in accordance
40 with the same brand licensee program as the contracting
41 entity; or
42 (2) an entity that is an affiliate of the contracting entity.
SB 136—LS 6590/DI 55 8
1 (b) For the purposes of this section, a contracting entity shall
2 make a list of the contracting entity's affiliates available to
3 providers on the contracting entity's Internet web site.
4 (c) Section 10 of this chapter does not apply to a provider
5 network contract established for the purpose of providing dental
6 services to beneficiaries of health programs sponsored by the state,
7 including Medicaid (IC 12-15) and the children's health insurance
8 program (IC 12-17.6).
9 Sec. 17. The provisions of this chapter cannot be waived by
10 contract. A contract provision that:
11 (1) conflicts with this chapter; or
12 (2) purports to waive any requirements of this chapter;
13 is null and void.
14 Sec. 18. (a) If a person violates this chapter, the insurance
15 commissioner may enter an order requiring the person to cease
16 and desist from violating this chapter.
17 (b) If a person violates a cease and desist order issued under
18 subsection (a), the insurance commissioner, after notice and
19 hearing under IC 4-21.5, may:
20 (1) impose a civil penalty upon the person of not more than
21 ten thousand dollars ($10,000) for each day of violation;
22 (2) suspend or revoke the person's certificate of authority, if
23 the person holds a certificate of authority under this title; or
24 (3) both impose a civil penalty upon the person under
25 subdivision (1) and suspend or revoke the person's certificate
26 of authority under subdivision (2).
SB 136—LS 6590/DI 55 9
COMMITTEE REPORT
Madam President: The Senate Committee on Insurance and
Financial Institutions, to which was referred Senate Bill No. 136, has
had the same under consideration and begs leave to report the same
back to the Senate with the recommendation that said bill be
AMENDED as follows:
Page 3, line 7, delete "The coverage of a dental service".
Page 3, delete lines 8 through 11.
and when so amended that said bill do pass.
(Reference is to SB 136 as introduced.)
ZAY, Chairperson
Committee Vote: Yeas 7, Nays 1.
SB 136—LS 6590/DI 55