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