Every entity providing a policy of accident and sickness insurance as defined in this chapter shall allow, as a provision in a group or individual policy, contract or health benefit plan for coverage of dental services, any person insured by such entity to direct, in writing, that benefits from a health benefit plan, policy or contract, be paid directly to a dental care provider who has not contracted with the entity to provide dental services to persons covered by the entity but otherwise meets the credentialing criteria of the entity and has not previously been terminated by such entity as a participating provider. If written direction to pay is executed and written notice of the direction to pay is provided to such entity, the insuring entity shall pay the benefits directly to the dental care provider. Any efforts to modify the amount of benefits paid directly to the dental care provider under this section may include a reduction in benefits paid of no more than five percent (5%) less than the benefits paid to participating dentists. The entity paying the dentist, pursuant to a direction to pay duly executed by the subscriber, shall have the right to review the records of the dentist receiving such payment that relate exclusively to that particular subscriber/patient to determine that the service in question was rendered. Provided, however, this section shall not apply to insurance coverage providing benefits for:
Terms Used In Rhode Island General Laws 27-18-63
- Contract: A legal written agreement that becomes binding when signed.
- health benefit plan: means health insurance coverage and a group health plan, including coverage provided through an association plan if it covers Rhode Island residents. See Rhode Island General Laws 27-18-1.1.
- in writing: include printing, engraving, lithographing, and photo-lithographing, and all other representations of words in letters of the usual form. See Rhode Island General Laws 43-3-16.
- insured: as used in this chapter , shall not be construed as preventing a person other than the insured with a proper insurable interest from making application for and owning a policy covering the insured or from being entitled under the policy to any indemnities, benefits, and rights provided in the policy. See Rhode Island General Laws 27-18-7.
- person: extends to and includes co-partnerships and bodies corporate and politic. See Rhode Island General Laws 43-3-6.
- Policy of accident and sickness insurance: as used in this chapter , includes any policy or contract covering against loss resulting from sickness or from bodily injury or death by accident, or both. See Rhode Island General Laws 27-18-1.
- provider: means a health care professional or a health care facility. See Rhode Island General Laws 27-18-1.1.
(1) Hospital confinement indemnity;
(2) Disability income;
(3) Accident only;
(4) Long-term care;
(5) Medicare supplement;
(6) Limited benefit health;
(7) Specified disease indemnity;
(8) Sickness or bodily injury or death by accident or both; and
(9) Other limited benefit policies.
(P.L. 2004, ch. 268, § 1; P.L. 2004, ch. 386, § 1.)