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 ENROLLED ACT No. 136
AN ACT to amend the Indiana Code concerning insurance.
Be it enacted by the General Assembly of the State of Indiana:
SECTION 1. IC 27-7-17.5 IS ADDED TO THE INDIANA CODE
AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2022]:
Chapter 17.5. Dental Plans Setting Fees for Dental Services
Sec. 1. As used in this chapter, "covered individual" means an
individual who is entitled to:
(1) dental services; or
(2) coverage of dental services.
Sec. 2. As used in this chapter, "covered service" means a dental
service for which a reimbursement:
(1) is available under a dental plan; or
(2) would be available under a dental plan but for the
application of contractual limitations such as:
(A) deductibles;
(B) copayments;
(C) coinsurance;
(D) waiting periods;
(E) annual or lifetime maximums;
(F) frequency limitations;
(G) alternative benefit payments; or
(H) any other limitation;
under the dental plan.
SEA 136 — Concur 2
Sec. 3. (a) As used in this chapter, "dental plan" means any of
the following:
(1) A policy issued by an insurer (as defined in IC 27-1-2-3(x))
that provides coverage for dental services.
(2) A contract under which a health maintenance organization
(as defined in IC 27-13-1-19) provides or covers dental
services.
(3) A preferred provider plan (as defined in IC 27-8-11-1(g))
that provides or covers dental services.
(b) The term does not include the following:
(1) A policy providing comprehensive coverage described in
Class 1(b) and Class 2(a) of IC 27-1-5-1.
(2) Accident only, Medicare supplement, long term care, or
disability income insurance.
(3) Coverage issued as a supplement to liability insurance.
(4) Automobile medical payment insurance.
(5) A specified disease policy.
(6) Worker's compensation or similar insurance.
(7) A student health plan.
(8) A supplemental plan that always pays in addition to other
coverage.
Sec. 4. As used in this chapter, "dental service" means any
service provided by a dentist within the scope of the dentist's
licensure under IC 25-14.
Sec. 5. As used in this chapter, "person" means an individual, a
corporation, a limited liability company, a partnership, or any
other legal entity.
Sec. 6. As used in this chapter, "provider" means:
(1) a dentist licensed under IC 25-14; or
(2) a dental office through which one (1) or more dentists
licensed under IC 25-14 provide dental services.
Sec. 7. A dental plan may not directly or indirectly require a
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.
Sec. 8. A third party administrator or other person that:
(1) is not a dental plan; but
(2) arranges for providers to provide dental services through
dental plans or through another sort of network
arrangement;
SEA 136 — Concur 3
shall not arrange for a provider to provide dental services for a
dental plan that sets the amount of the fee for the dental services
unless the dental services are covered services under the dental
plan.
Sec. 9. (a) If:
(1) an insurer (as defined in IC 27-1-2-3(x));
(2) a health maintenance organization (as defined in
IC 27-13-1-19);
(3) a preferred provider plan (as defined in IC 27-8-11-1(g));
or
(4) any other person;
violates this chapter, the insurance commissioner may enter an
order requiring the person to cease and desist from violating this
chapter.
(b) If a person violates a cease and desist order issued under
subsection (a), the insurance commissioner, after notice and
hearing under IC 4-21.5, may:
(1) impose a civil penalty upon the person of not more than
ten thousand dollars ($10,000) for each day of violation;
(2) suspend or revoke the person's certificate of authority, if
the person holds a certificate of authority under this title; or
(3) both impose a civil penalty upon the person under
subdivision (1) and suspend or revoke the person's certificate
of authority under subdivision (2).
SEA 136 — Concur President of the Senate
President Pro Tempore
Speaker of the House of Representatives
Governor of the State of Indiana
Date: Time:
SEA 136 — Concur