THE GENERAL ASSEMBLY OF PENNSYLVANIA

SENATE BILL

INTRODUCED BY WARD, D. WHITE, VOGEL, SOLOBAY, BROWNE, ERICKSON, WAUGH, WASHINGTON, ALLOWAY, LEACH, BOSCOLA, BLAKE, FARNESE AND SCHWANK, JUNE 15, 2011

SENATOR DON WHITE, BANKING AND INSURANCE, AS AMENDED, APRIL 2, 2012   

AN ACT

Amending the act of July 2, 1996 (P.L.514, No.85), entitled "An

act providing for certain health insurance benefits to aid

the health and well-being of mother and child following the

birth of a child; and prohibiting certain practices by

insurers," defining "covered dentist services"; and

prohibiting insurers from setting fees for noncovered dentist

services.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1.  Section 2 of the act of July 2, 1996 (P.L.514,

No.85), known as the Health Security Act, is amended by adding a

definition to read:

Section 2.  Definitions.

The following words and phrases when used in this act shall

have the meanings given to them in this section unless the

context clearly indicates otherwise:

"Covered dentist services."  Dental care services for which

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reimbursement is available under an employee's plan contract.

The term includes dental care services for which a reimbursement

would be available if not for annual maximums services for which

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reimbursement is available under an insured's policy, regardless

of whether the reimbursement is contractually limited by a

deductible, copayment, coinsurance, waiting period, annual or

lifetime maximum, frequency limitation or alternative benefit

payment.

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Section 2.  The act is amended by adding a section to read:

Section 4.1.  Fees for noncovered dentist services.

(a)  Prohibition.--An insurer's contract with a dentist may

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not require that the dentist provide services to the insurer's

subscribers insureds at a fee set by the insurer unless the

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insurer compensates the dentist for covered dentist services 

those services are covered dentist services.

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(b)  Effect.--A contractual provision in violation of

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subsection (a) is void.

Section 3.  The addition of section 4.1 of the act shall

apply to insurance policies issued or renewed on or after the

effective date of this section.

Section 4.  This act shall take effect in 60 days.