Massachusetts 2025-2026 Regular Session

Massachusetts Senate Bill S808 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. 2395 FILED ON: 1/17/2025
3	3	SENATE . . . . . . . . . . . . . . No. 808
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 consumer protections.
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. 2395 FILED ON: 1/17/2025
17	17	SENATE . . . . . . . . . . . . . . No. 808
18	18	By Mr. O'Connor, a petition (accompanied by bill, Senate, No. 808) of Patrick M. O'Connor for
19	19	legislation relative to dental insurance consumer protections. Financial Services.
20	20	[SIMILAR MATTER FILED IN PREVIOUS SESSION
21	21	SEE SENATE, NO. 697 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 consumer protections.
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 Chapter 176X of the General Laws, as appearing in the 2020 Official Edition, are hereby
31	31	2amended by adding the following chapter:-
32	32	3 Chapter 176Y
33	33	4 SECTION 1. DISCLOSURE OF BENEFIT TERMS.
34	34	5 (a) An employee benefit plan or health insurance policy shall: (1) if applicable, disclose
35	35	6that the benefit for dental care services offered is limited to the least costly treatment; and (2)
36	36	7specify in dollars and cents the amount of the payment or reimbursement to be provided for
37	37	8dental care services or define AND explain the standard on which payment of benefits or
38	38	9reimbursement for the cost of dental care services is based, such as: (A) "usual and customary" 2 of 3
39	39	10fees; (B) "reasonable and customary fees; (C) "usual, customary, and reasonable" fees; or (D)
40	40	11preset fee schedule or (E) words of similar meaning.
41	41	12 (b) A person or entity who provides or issues an employee benefit plan or health
42	42	13insurance policy or the employer or employee organization, if applicable, shall establish an
43	43	14Internet website to provide resources and accurate information to dentists, insureds, participants,
44	44	15employees, and members, including the standard on which reimbursement is based.
45	45	16 (c) An employee benefit plan or health insurance policy shall make accessible on the
46	46	17Internet website established under subsection (b) information about the plan or policy sufficient
47	47	18for patients and dentists to determine the type of dental care services covered by the plan or
48	48	19policy and the amount of the payment or reimbursement available for those services under the
49	49	20plan or policy. Access to the Internet website must be at no charge to patients under the plan or
50	50	21policy and dentists providing dental care services to the patients whether in network or out of
51	51	22network.
52	52	23 SECTION 2.
53	53	24 (a) The employee benefit plan or health insurance policy shall: (1) provide: (A) that
54	54	25payment or reimbursement for a noncontracting provider dentist shall be the same or greater as
55	55	26payment or reimbursement for a contracting provider dentist; (B) that the party to or
56	56	27beneficiary of the plan or policy may assign the right to payment or reimbursement to the
57	57	28dentist who provides the dental care services; and (C) one or more methods of payment or
58	58	29reimbursement that provide the dentist 100 percent of the contracted amount of the payment or
59	59	30reimbursement and that do not require the dentist to incur a fee to access the payment or
60	60	31reimbursement; and (2) disclose on the Internet website required under and on request of a 3 of 3
61	61	32dentist or a party to or beneficiary of the plan or policy the fees, if any, associated with the
62	62	33methods of payment or reimbursement available under the plan or policy.
63	63	34 SECTION 3.
64	64	35 (a) An employee benefit plan or health insurance policy may not: (1) interfere with or
65	65	36prevent an individual who is a party to or beneficiary of the plan or policy from selecting a
66	66	37dentist of the individual's choice to provide a dental care service the plan or policy offers if the
67	67	38dentist selected is licensed in this state to provide the service; (2) deny a dentist the right to
68	68	39participate as a contracting provider under the plan or policy if the dentist is licensed to provide
69	69	40the dental care services the plan or policy offers; (3) authorize a person to regulate, interfere
70	70	41with, or intervene in the provision of dental care services a dentist provides a patient, including
71	71	42diagnosis, if the dentist practices within the scope of the dentist's license; (4) require a dentist
72	72	43to make or obtain a dental x-ray or other diagnostic aid in providing dental care services; or (5)
73	73	44deduct the amount of an overpayment of a claim from a payment or reimbursement of another
74	74	45claim unless both claims were for dental services provided to the same patient by the same
75	75	46dentist.
76	76	47 (b) This section does not prohibit the predetermination of benefits for dental care
77	77	48expenses before the attending dentist provides treatment. An employee benefit plan or health
78	78	49insurance policy that provides a written predetermination of benefits to a dentist with respect to a
79	79	50dental care service for a patient that includes a specific benefit payment or reimbursement
80	80	51amount may not pay or reimburse the dentist for providing that service to the patient in an
81	81	52amount that is less than the amount set forth in the predetermination.