Massachusetts 2025-2026 Regular Session

Massachusetts Senate Bill S807 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	1 of 1
2	2	SENATE DOCKET, NO. 2394 FILED ON: 1/17/2025
3	3	SENATE . . . . . . . . . . . . . . No. 807
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	Patrick M. O'Connor
8	8	_________________
9	9	To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
10	10	Court assembled:
11	11	The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
12	12	An Act relative to dental insurance assignment of benefits.
13	13	_______________
14	14	PETITION OF:
15	15	NAME:DISTRICT/ADDRESS :Patrick M. O'ConnorFirst Plymouth and Norfolk 1 of 3
16	16	SENATE DOCKET, NO. 2394 FILED ON: 1/17/2025
17	17	SENATE . . . . . . . . . . . . . . No. 807
18	18	By Mr. O'Connor, a petition (accompanied by bill, Senate, No. 807) of Patrick M. O'Connor for
19	19	legislation relative to dental insurance assignment of benefits. Financial Services.
20	20	[SIMILAR MATTER FILED IN PREVIOUS SESSION
21	21	SEE SENATE, NO. 698 OF 2023-2024.]
22	22	The Commonwealth of Massachusetts
23	23	_______________
24	24	In the One Hundred and Ninety-Fourth General Court
25	25	(2025-2026)
26	26	_______________
27	27	An Act relative to dental insurance assignment of benefits.
28	28	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
29	29	of the same, as follows:
30	30	1 SECTION 1. Chapter 176W of the General Laws, as so appearing the 2020 Official
31	31	2Edition, is hereby amended by inserting the following chapter:-
32	32	3 Chapter 176X. Dental Benefit Plans
33	33	4 Section 1. As used in this chapter the following words shall, unless the context clearly
34	34	5requires otherwise, have the following meaning:-
35	35	6 “Carrier”, any insurer licensed or otherwise authorized to transact accident and health
36	36	7insurance under chapter 175, non-profit medical service corporation under chapter 176B; a
37	37	8dental service corporation organized under chapter 176E, health maintenance organization
38	38	9organized under chapter 176G, or preferred provider arrangement organized under chapter 176I
39	39	10offering dental benefit plans in the commonwealth. 2 of 3
40	40	11 “Commissioner”, the commissioner of the division of insurance.
41	41	12 “Connector”, the commonwealth health insurance connector, established by chapter
42	42	13176Q.
43	43	14 “Dental benefit plans”, any stand-alone dental plan that covers oral surgical care,
44	44	15services, procedures or benefits covered by any individual, general, blanket or group policy of
45	45	16health, accident and sickness insurance issued by an insurer licensed or otherwise authorized to
46	46	17transact accident and health insurance under chapter 175; any oral surgical care, services,
47	47	18procedures or benefits covered by a stand-alone individual or group dental medical service plan
48	48	19issued by a non-profit medical service corporation under chapter 176B; any oral surgical care,
49	49	20services, procedures or benefits covered by a stand-alone individual or group dental service plan
50	50	21issued by a dental service corporation organized under chapter 176E; any oral surgical care,
51	51	22services, procedures or benefits covered by a stand-alone individual or group dental health
52	52	23maintenance contract issued by a health maintenance organization organized under chapter
53	53	24176G; or any oral surgical care, services, procedures or benefits covered by a stand-alone
54	54	25individual or group preferred provider dental plan issued by a preferred provider arrangement
55	55	26organized under chapter 176I.
56	56	27 “Self-insured customer”, a self-insured group for which a carrier provides administrative
57	57	28services.
58	58	29 “Self-insured group”, a self-insured or self-funded employer group health plan.
59	59	30 “Third-party administrator”, a person who, on behalf of a dental insurer or purchaser of
60	60	31dental benefits, receives or collects charges, contributions or premiums for, or adjusts or settles
61	61	32claims on or for residents of the commonwealth. 3 of 3
62	62	33 “Written direction” refers to the assignment of benefits to the dental provider by the
63	63	34patient on the claim form sent electronically or by regular mail to the dental plan.
64	64	35 Section 2. Dental insurance assignment of benefits. Dental benefit plans as defined in
65	65	36section 1 shall allow, as a provision in a group or individual policy, contract or health benefit
66	66	37plan for coverage of dental services, any person insured by such entity to direct, in writing, that
67	67	38benefits from a health benefit plan, policy or contract, be paid directly to a dental care provider
68	68	39who has not contracted with the entity to provide dental services to persons covered by the entity
69	69	40but otherwise meets the credentialing criteria of the entity. If written direction to pay is executed
70	70	41and written notice of the direction to pay is provided to such entity, the insuring entity shall pay
71	71	42the benefits directly to the dental care provider. The amount of benefits paid directly to the dental
72	72	43care provider under this section must be at least equal to the amount paid to participating
73	73	44dentists. The entity paying the dentist, pursuant to a direction to pay duly executed by the
74	74	45subscriber, shall have the right to review the records of the dentist receiving such payment that
75	75	46relate exclusively to that particular subscriber/patient to determine that the service in question
76	76	47was rendered. Provided, however, this section shall not apply to insurance coverage providing
77	77	48benefits for: (1) hospital confinement indemnity; (2) disability income; (3) accident only; (4)
78	78	49long-term care; (5) Medicare supplement; (6) limited benefit health; (7) specified disease
79	79	50indemnity; (8) sickness or bodily injury or death by accident or both; and (9) other limited
80	80	51benefit policies.