Report Title:

Dental Plans; Dual Coverage

 

Description:

Requires health insurers and like entities who offer dental coverage to declare and execute their coordination of dental benefits policy to insureds and their counterparts.

 


HOUSE OF REPRESENTATIVES

H.B. NO.

1208

TWENTY-FIFTH LEGISLATURE, 2009

 

STATE OF HAWAII

 

 

 

 

 

A BILL FOR AN ACT

 

 

RELATING TO DENTAL CARE.

 

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 


SECTION 1. Chapter 431, article 10A, Hawaii Revised Statutes, is amended by adding a new section to part II to be appropriately designated and to read as follows:

"431:10A- Coordination of dental benefits. (a) This section shall apply to a group or blanket disability insurance policy covering dental services and issued under this article.

(b) For purposes of this section, the following terms have the following meanings:

(1) "Coordination of dental benefits" means the method by which a policy or contract under title 24 covering dental services and one or more other policies or contracts under title 24 covering dental services pay their respective reimbursements for dental benefits when an insured, beneficiary, subscriber, member, or enrollee is covered by multiple policies or contracts under title 24 covering dental services;

(2) "Primary dental benefits plan" means a policy or contract under title 24 that provides an insured, beneficiary, subscriber, member, or enrollee with primary dental coverage; and

(3) "Secondary dental benefits plan" means a policy or contract under title 24 that provides an insured, beneficiary, subscriber, member, or enrollee with secondary dental coverage.

(c) A group or blanket disability insurance policy covering dental services shall declare its coordination of dental benefits policy prominently in its evidence of coverage or contract with the insured.

(d) A group or blanket disability insurance policy covering dental services, when acting as a primary dental benefits plan, shall pay the maximum amount required by its contract with the insured.

(e) A group or blanket disability insurance policy covering dental services, when acting as a secondary dental benefits plan, shall pay the lesser of either the amount that it would have paid in the absence of any other dental benefits coverage, or the insured or beneficiary's total out-of-pocket cost payable under the primary dental benefits plan for benefits covered under the secondary plan.

(f) Nothing in this section is intended to conflict with or modify the way in which a group or blanket disability insurance policy covering dental services determines which dental benefits plan is primary and which is secondary in coordinating benefits with another plan or insurer pursuant to existing state law or regulation."

SECTION 2. Chapter 432, article 1, Hawaii Revised Statutes, is amended by adding a new section to part VI to be appropriately designated and to read as follows:

"432:1- Coordination of dental benefits. (a) This section shall apply to any individual or group hospital or medical service plan contract covering dental services and issued under this article.

(b) For purposes of this section, the following terms have the following meanings:

(1) "Coordination of benefits" means the method by which a policy or contract under title 24 covering dental services and one or more other policies or contracts under title 24 covering dental services pay their respective reimbursements for dental benefits when an insured, beneficiary, subscriber, member, or enrollee is covered by multiple policies or contracts under title 24 covering dental services;

(2) "Primary dental benefits plan" means a policy or contract under title 24 that provides an insured, beneficiary, subscriber, member, or enrollee with primary dental coverage; and

(3) "Secondary dental benefits plan" means a policy or contract under title 24 that provides an insured, beneficiary, subscriber, member, or enrollee with secondary dental coverage.

(c) An individual or group hospital or medical service plan contract covering dental services shall declare its coordination of benefits policy prominently in its evidence of coverage or contract with the subscriber.

(d) An individual or group hospital or medical service plan contract covering dental services, when acting as a primary dental benefits plan, shall pay the maximum amount required by its contract with the subscriber.

(e) An individual or group hospital or medical service plan contract covering dental services, when acting as a secondary dental benefits plan, shall pay the lesser of either the amount that it would have paid in the absence of any other dental benefit coverage, or the subscriber or member's total out-of-pocket cost payable under the primary dental benefits plan for benefits covered under the secondary plan.

(f) Nothing in this section is intended to conflict with or modify the way in which an individual or group hospital or medical service plan contract covering dental services determines which dental benefits plan is primary and which is secondary in coordinating benefits with another plan or insurer pursuant to existing state law or regulation."

SECTION 3. Chapter 432D, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"432D- Coordination of dental benefits. (a) This section shall apply to any policy, contract, plan, or agreement covering dental services and issued under this chapter.

(b) For purposes of this section, the following terms have the following meanings:

(1) "Coordination of benefits" means the method by which a policy or contract under title 24 covering dental services and one or more other policies or contracts under title 24 covering dental services pay their respective reimbursements for dental benefits when an insured, beneficiary, subscriber, member, or enrollee is covered by multiple policies or contracts under title 24 covering dental services;

(2) "Primary dental benefits plan" means a policy or contract under title 24 that provides an insured, beneficiary, subscriber, member, or enrollee with primary dental coverage; and

(3) "Secondary dental benefits plan" means a policy or contract under title 24 that provides an insured, beneficiary, subscriber, member, or enrollee with secondary dental coverage.

(c) Any policy, contract, plan, or agreement covering dental services and issued under this chapter shall declare its coordination of benefits policy prominently in its evidence of coverage or contract with the contract holder.

(d) Any policy, contract, plan, or agreement covering dental services and issued under this chapter, when acting as a primary dental benefits plan, shall pay the maximum amount required by its contract with the contract holder.

(e) Any policy, contract, plan, or agreement covering dental services and issued under this chapter, when acting as a secondary dental benefits plan, shall pay the lesser of either the amount that it would have paid in the absence of any other dental benefit coverage, or the enrollee's total out-of-pocket cost payable under the primary dental benefits plan for benefits covered under the secondary plan.

(f) Nothing in this section is intended to conflict with or modify the way in which any policy, contract, plan, or agreement covering dental services and issued under this chapter determines which dental benefits plan is primary and which is secondary in coordinating benefits with another plan or insurer pursuant to existing state law or regulation."

SECTION 4. This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun, before its effective date.

SECTION 5. New statutory material is underscored.

SECTION 6. This Act shall take effect upon its approval.

 

INTRODUCED BY:

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