1.This Act may be cited as the
Dental Insurance Fairness Act of
2012
.
2.Congress finds 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 2012 will help consumers receive the full value of
their dental coverage.
3.Value
requirements for dental benefitsSubpart B of part 7 of subtitle B of title I
of the Employee Retirement Income Security Act of 1974 is amended by adding at
the end the following:
716.Value
requirements for dental benefits
(a)The requirements of
this section shall apply to group health plans insofar as they provide dental
benefits (including, notwithstanding section 732(c)(1), limited scope dental
benefits (described in section 733(c)(2))), directly, through health insurance
coverage, or otherwise.
(b)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 benefitsThe
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 the Secretary establishes, based upon similar model regulations
developed by the National Association of Insurance commissioners.
(2)Equity for
dental patients through assignment of benefitsIn 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.
.