1.1 A bill for an act
1.2 relating to insurance; changing definition of covered services for dental care;
1.3 amending Minnesota Statutes 2024, section 62Q.78, subdivision 6.
1.4BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.5 Section 1. Minnesota Statutes 2024, section 62Q.78, subdivision 6, is amended to read:
1.6 Subd. 6.Payment for covered services.(a) No contract of any dental plan or dental
1.7organization that covers any dental services or dental provider agreement with a dentist
1.8may require, directly or indirectly, that a dentist provide services to an enrolled participant
1.9at a fee set by, or at a fee subject to the approval of, the dental plan or dental organization
1.10unless the dental services are covered services.
1.11 (b) A dental plan or dental organization or other person providing third-party
1.12administrator services shall not make available any providers in its dentist network to a plan
1.13that sets dental fees for any services except covered services.
1.14 (c) "Covered services" means dental care services for which a reimbursement is available
1.15under an enrollee's plan contract, or for which a reimbursement would be available but for
1.16the application of contractual limitations such as deductibles, co-payments, coinsurance,
1.17waiting periods, annual or lifetime maximums, frequency limitations, alternative benefit
1.18payments, or any other limitation that are reimbursed in whole or in part under a dental
1.19provider agreement.
1.20 (d) A dentist may not charge more than the dentist's usual and customary rate for services
1.21or procedures that are not covered services.
1Section 1.
25-00690 as introduced12/11/24 REVISOR SGS/LN
SENATE
STATE OF MINNESOTA
S.F. No. 1137NINETY-FOURTH SESSION
(SENATE AUTHORS: BOLDON, Utke, Mann and Gruenhagen)
OFFICIAL STATUSD-PGDATE
Introduction and first reading02/10/2025
Referred to Commerce and Consumer Protection 2.1 (e) Prior to providing a patient with dental services that are not a covered service under
2.2the terms of a dental plan contract, the dentist should provide to the patient a treatment plan
2.3that includes each anticipated service or procedure to be provided and the estimate cost of
2.4each service or procedure.
2.5 (f) Nothing in this section shall be construed as limiting the ability of a dental plan or
2.6dental organization or other person providing third party administrator services to restrict
2.7any of the following as they relate to covered services:
2.8 (1) balance billing;
2.9 (2) waiting periods;
2.10 (3) frequency limitations;
2.11 (4) deductibles; or
2.12 (5) maximum annual benefits.
2Section 1.
25-00690 as introduced12/11/24 REVISOR SGS/LN