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H.R. 1798 (113th): Dental Insurance Fairness Act of 2013

The text of the bill below is as of Apr 26, 2013 (Introduced).


I

113th CONGRESS

1st Session

H. R. 1798

IN THE HOUSE OF REPRESENTATIVES

April 26, 2013

(for himself,Mr. Simpson,Mr. Andrews, andMr. Loebsack) introduced the following bill; which was referred to theCommittee on Education and the Workforce

A BILL

To amend the Employee Retirement Income Security Act of 1974 to ensure health care coverage value and transparency for dental benefits under group health plans.

1.

Short title

This Act may be cited as the Dental Insurance Fairness Act of 2013 .

2.

Findings

Congressfinds the following:

(1)

Dental coverage helps approximately 173 million Americans get the dental care that is vital to ensuring good oral and overall health.

(2)

Unfair practices of dental benefit plans hinder patients’ ability to receive the full benefits for which they pay and, in some cases, provide the dental insurance industry with windfall profits.

(3)

The Dental Insurance Fairness Act of 2013 will help consumers receive the full value of their dental coverage.

3.

Value requirements for dental benefits

Subpart B of part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974( 29 U.S.C. 1185 et seq. )is amended by adding at the end the following:

716.

Value requirements for dental benefits

(a)

In general

The requirements of this section shall apply to self-insured group health plans insofar as they provide dental benefits (including, notwithstandingsection 732(c)(1), self-insured limited scope dental benefits (described insection 733(c)(2))).

(b)

Value

In order to ensure that participants and beneficiaries in a group health plan receive full value from dental benefits, the plan shall meet the following requirements:

(1)

Uniform coordination of benefits

The plan shall provide for coordination of benefits in a manner so that the plan pays the same amount regardless of other coverage for such benefits so long as the total amount paid does not exceed 100 percent of the amount of the applicable claim. Such coordination shall be effected consistent with such rules as theSecretaryestablishes, based upon similar model regulations developed by the National Association of Insurance commissioners.

(2)

Equity for dental patients through assignment of benefits

In the case of a plan that provides dental benefits through a network of providers, the plan shall permit a participant or beneficiary to designate payment of dental benefits to a provider who is not participating in the network.

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