Tennessee Code 56-7-1017 v2 – Prohibition against a dental insurance plan from requiring a participating dentist to provide services to covered individuals at a fee set by the plan
Contract: A legal written agreement that becomes binding when signed.
State: when applied to the different parts of the United States, includes the District of Columbia and the several territories of the United States. See Tennessee Code 1-3-105
(1) “Covered services” means dental care for which a reimbursement is available under the enrollee’s plan contract, or for which a reimbursement would be available but for the application of contractual limitations such as deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums, frequency limitations, alternative benefits payments, or any other limitation; and(2) “Participating provider” means a dentist licensed to practice dentistry in this state, who provides dental services to an enrollee at a fee set by or at a fee subject to the approval of an insurer, dental services plan, third party administrator or any other party that contracts to provide dental services.(b) No contract offered by any insurer, dental service plan, third party administrator or other party that covers any dental services, and no contract or participating provider agreement with a dentist may require, directly or indirectly, that a dentist who is a participating provider, provide services to an enrollee at a fee set by, or at a fee subject to the approval of the dental service plan, insurer, third party administrator or other party that covers any dental plan services unless the dental services are covered services.(c) No contract offered by any insurer, dental service plan, third party administrator or other party with a participating provider that covers any covered services may provide nominal or de minimis coverage for covered services under the contract for the sole purpose of avoiding the requirements of this section.(d) Nothing in this section shall apply to the TennCare program and any medical assistance provided pursuant to title 71, chapter 5, or to the state children’s health insurance program established under title XXI of the Social Security Act, subchapter XXI, chapter 7 of title 42 (42 U.S.C. § 1397aa et seq.).(e) A violation of this section may subject the insurer, dental service plan, third-party administrator, or other party that covers any dental services to the sanctions described in § 56-2-305.
