| 1 | 1 | | 1.1 A bill for an act |
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| 2 | 2 | | 1.2 relating to insurance; changing definition of covered services for dental care; |
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| 3 | 3 | | 1.3 amending Minnesota Statutes 2024, section 62Q.78, subdivision 6. |
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| 4 | 4 | | 1.4BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: |
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| 5 | 5 | | 1.5 Section 1. Minnesota Statutes 2024, section 62Q.78, subdivision 6, is amended to read: |
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| 6 | 6 | | 1.6 Subd. 6.Payment for covered services.(a) No contract of any dental plan or dental |
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| 7 | 7 | | 1.7organization that covers any dental services or dental provider agreement with a dentist |
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| 8 | 8 | | 1.8may require, directly or indirectly, that a dentist provide services to an enrolled participant |
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| 9 | 9 | | 1.9at a fee set by, or at a fee subject to the approval of, the dental plan or dental organization |
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| 10 | 10 | | 1.10unless the dental services are covered services. |
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| 11 | 11 | | 1.11 (b) A dental plan or dental organization or other person providing third-party |
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| 12 | 12 | | 1.12administrator services shall not make available any providers in its dentist network to a plan |
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| 13 | 13 | | 1.13that sets dental fees for any services except covered services. |
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| 14 | 14 | | 1.14 (c) "Covered services" means dental care services for which a reimbursement is available |
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| 15 | 15 | | 1.15under an enrollee's plan contract, or for which a reimbursement would be available but for |
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| 16 | 16 | | 1.16the application of contractual limitations such as deductibles, co-payments, coinsurance, |
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| 17 | 17 | | 1.17waiting periods, annual or lifetime maximums, frequency limitations, alternative benefit |
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| 18 | 18 | | 1.18payments, or any other limitation that are reimbursed in whole or in part under a dental |
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| 19 | 19 | | 1.19provider agreement. |
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| 20 | 20 | | 1.20 (d) A dentist may not charge more than the dentist's usual and customary rate for services |
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| 21 | 21 | | 1.21or procedures that are not covered services. |
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| 22 | 22 | | 1Section 1. |
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| 23 | 23 | | REVISOR SGS/LN 25-0069012/11/24 |
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| 24 | 24 | | State of Minnesota |
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| 25 | 25 | | This Document can be made available |
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| 26 | 26 | | in alternative formats upon request |
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| 27 | 27 | | HOUSE OF REPRESENTATIVES |
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| 28 | 28 | | H. F. No. 1474 |
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| 29 | 29 | | NINETY-FOURTH SESSION 2.1 (e) Prior to providing a patient with dental services that are not a covered service under |
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| 30 | 30 | | 2.2the terms of a dental plan contract, the dentist should provide to the patient a treatment plan |
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| 31 | 31 | | 2.3that includes each anticipated service or procedure to be provided and the estimate cost of |
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| 32 | 32 | | 2.4each service or procedure. |
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| 33 | 33 | | 2.5 (f) Nothing in this section shall be construed as limiting the ability of a dental plan or |
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| 34 | 34 | | 2.6dental organization or other person providing third party administrator services to restrict |
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| 35 | 35 | | 2.7any of the following as they relate to covered services: |
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| 36 | 36 | | 2.8 (1) balance billing; |
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| 37 | 37 | | 2.9 (2) waiting periods; |
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| 38 | 38 | | 2.10 (3) frequency limitations; |
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| 39 | 39 | | 2.11 (4) deductibles; or |
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| 40 | 40 | | 2.12 (5) maximum annual benefits. |
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| 41 | 41 | | 2Section 1. |
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| 42 | 42 | | REVISOR SGS/LN 25-0069012/11/24 |
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