(a) A health care insurer who provides coverage for dental care may not include in the health care insurance plan or contract a provision that
Terms Used In Alaska Statutes 21.42.392
action: includes any matter or proceeding in a court, civil or criminal. See Alaska Statutes 01.10.060
Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
Contract: A legal written agreement that becomes binding when signed.
person: includes a corporation, company, partnership, firm, association, organization, business trust, or society, as well as a natural person. See Alaska Statutes 01.10.060
state: means the State of Alaska unless applied to the different parts of the United States and in the latter case it includes the District of Columbia and the territories. See Alaska Statutes 01.10.060
(1) prohibits a covered person from obtaining dental care services from a dentist of the person’s choice, including a specialist;(2) restricts a covered person’s right to receive full information from the person’s dentist regarding the care or treatment options that the dentist believes are in the best interests of the person.(b) A health care insurance plan or contract that provides coverage for dental services that allows the health care insurer to review a treatment plan or conduct a utilization review must contain a provision that a treatment plan review or utilization review relating to dental care for a covered person receiving treatment in this state must be conducted by a dentist if the claim for reimbursement or payment is denied.(c) A health care insurer that provides coverage for dental care
(1) may reimburse a covered person at a different rate because of the person’s choice of a dentist if the dentist is not a part of the covered person’s dental network or preferred provider organization agreement; the covered expense for non-network providers may not be less than that allowed to a network provider, although the covered expense may be reimbursed at a lower percentage or with higher deductibles than if the service had been provided within the network;(2) may not limit a fee set by a dentist for a service unless the service is covered under the insurer’s plan or contract; and(3) may offer a dentist the option of entering into a preferred provider contract with the insurer that provides a fee schedule for covered services only or a fee schedule for both covered and uncovered services; under this paragraph,
(A) the health care insurer may not
(i) take an action against the dentist based on the dentist’s refusal to enter into a contract with an insurer;(ii) fail to list a dentist who does not enter into a contract with an insurer in the insurer’s marketing materials; or(iii) take action against the dentist during the management or administration of a contract based on the dentist’s choice of contract;(B) the terms or provisions of the contract
(i) may not violate Alaska Stat. § 45.50.562 – 45.50.566; and(ii) may authorize the insurer to provide information to the insured describing the dentist’s choice of contract and fee schedules;(C) “covered service” means a health care service for which a health care insurer pays a benefit for all or part of the service, including a benefit that is available but limited by deductible, coinsurance, or frequency terms under the contract between the insurer and the insured.(d) A health care insurer may not deny
(1) dental coverage, cancel a health care insurance plan or contract, or otherwise take action against a covered person or a dentist because the person has asserted a right described in this section;(2) dental coverage or eligibility for dental coverage because the covered person chooses a dentist outside of a preferred provider organization agreement.(e) A covered person may bring a civil action against a health care insurer to enforce the person’s rights under this section if the covered person has exhausted the administrative appeal process.(f) A dentist who treats a covered person may not waive uncovered dental expenses for which the covered person has liability because a covered person chose the dentist outside of a dental network or a preferred provider organization agreement.(g) In this section,
(1) “covered expense” means charges that are payable under plan provisions;(2) “dentist” means a person licensed to practice dentistry;(3) “preferred provider” means a dental provider who has signed an agreement with a dental care plan to provide services to plan participants at a specific rate.
