What's happening
This bill prohibits insurers from requiring dentists to discount fees for services not covered under a patient's dental plan.
Why it matters
Protects dentists’ autonomy and fee-setting. By stopping insurers from dictating fees for non-covered services, this bill ensures dentists can independently set prices for procedures not included in a patient’s plan, potentially improving provider satisfaction and business sustainability.
Limits insurer influence on out-of-pocket costs. Patients may see changes in what they pay for uncovered dental procedures, as insurers will no longer indirectly control these costs through provider contracts, making costs more transparent but possibly higher.
Clarifies what counts as a "covered service". The bill defines covered services broadly to include those subject to deductibles, copays, maximums, or waiting periods, aiming to avoid loopholes and ensuring the rule applies consistently across various plan designs.
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Who cares
Headline styles
Protect Dental Pricing Freedom
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Vetoed memo.237
- Delivered to governor
- Returned to senate
- Passed assembly
- Ordered to third reading rules cal.623
- Substituted for A8141A
- Referred to insurance
- Delivered to assembly
- Passed senateVote 62–0
- Ordered to third reading cal.1742
- Committee discharged and committed to rules
- Print number 6496a
Show 2 earlier actions
- Amend and recommit to insurance
- Referred to insurance
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Protect Uninsured Dental Discounts
Assembly Floor Calendar · Sponsor Steven Cymbrowitz
Full text
1 pageUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
6496--A
2017-2018 Regular Sessions
IN SENATE
May 25, 2017
Introduced by Sen. O'MARA -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee
AN ACT to amend the insurance law, in relation to discounting uninsured dental services
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Section 4224 of the insurance law is amended by adding a new subsection (g) to read as follows:
(g) Notwithstanding any other provision of this section, no insurer or managed care entity authorized to do business in this state shall include any provision in any of its contracts with a dentist which requires that a dentist provide services to a covered person at a fee set by, or at a fee subject to the approval of, the insurer or managed care entity unless the dental services are a covered service under the person's dental plan. For purposes of this subsection, "covered services" shall mean dental care services for which a reimbursement is available under an 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 benefit payments, or any other limitation.
§ 2. This act shall take effect on January 1, 2018, and shall apply to all insurance and managed care contracts issued or entered into on or after January 1, 2018.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD11925-02-7
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act to amend the insurance law, in relation to discounting uninsured dental services
Purpose or general idea of bill
To prevent insurance companies from including in their contracts any provisions that relate to or affect dental services that they do not insure.
Summary of specific provisions
Section 1 prevents an insurance or managed care company from including in any insurance or managed care contract any provisions that relate to or affect dental services that are not covered by the contract.
Section 2 makes the bill effective January 1, 2018, and applicable to any insurance or managed care contracts issued or entered into on or after that date.
Justification
Existing New York State Insurance Law - Section 4224(d) (1) of the Insurance Law - prohibits interdependent sales whereby an, insurer puts into its insurance policies products or services that are not insured as a means of interdependently selling that policy and the uninsured items to its insureds. Some insurers are routinely flouting that law by including in their dental plans discounts on dental services they do not insure and then requiring dentists to provide such discounts in order to be a participating provider in the dental insurance plan. In effect, the insurer subsidizes the sale of its insurance plan to patients by using money from dentists offered in the form of discounts on uninsured dental services. Simultaneously, the insurer is selling that discount product to patients as part of the insurance policy as an inducement to buy the insurance policy. This pernicious marketing practice to sell dental insurance plans by coupling them to discounts on uninsured dental services has been allowed to continue because regulators have had difficulty distinguishing between insured and uninsured dental services. The bill makes it clear that no insurer can place into their contracts any provisions relating to dental services that they do not insure.
This bill is necessary to restore sensible enforcement of the law against interdependent sales with respect to dental insurance plans. Many other states have outlawed this practice directly in a similar way, using the logic that dental insurers should not be influencing the prices or other aspects of dental services that they do not insure at all and never pay for. However, New York does not need this logic, compelling though it is, because New York long ago prevented interdependent sales schemes in insurance plans and this law merely clarifies that it applies to uninsured dental services as it would to any other improper interdependent sales scheme. Several dental insurers, including Cigna and Delta Dental, do not engage in this practice in New York in recognition of the pernicious aspects of doing so. The law is timed to take effect on January 1, 2018, and only to apply to insurance or managed care contracts issued or entered into on or after that date.
Prior legislative history
None.
Fiscal implications
None to the state. EFFECTIVE DATE : This act shall take effect on January 1, 2018, and apply to insurance and managed care contracts issued or entered into on or after that date.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.