Dental Coverage Value and Transparency Act of 2010 - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to prescribe certain health care coverage value and transparency requirements for dental benefits under group health plans.
[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5000 Introduced in House (IH)]
111th CONGRESS
2d Session
H. R. 5000
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.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
April 13, 2010
Mr. Andrews introduced the following bill; which was referred to the
Committee on Education and Labor
_______________________________________________________________________
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.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Dental Coverage Value and
Transparency Act of 2010''.
SEC. 2. VALUE AND TRANSPARENCY REQUIREMENTS FOR DENTAL BENEFITS.
(a) In General.--Subpart B of part 7 of subtitle A of title I of
the Employee Retirement Income Security Act of 1974 is amended by
adding at the end the following new section:
``SEC. 716. VALUE AND TRANSPARENCY REQUIREMENTS FOR DENTAL BENEFITS.
``(a) In General.--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) 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
the Secretary establishes, based upon similar model regulations
developed by the National Association of Insurance
commissioners.
``(2) Equity for out-of-network providers through
assignment of benefits and comparable payments.--In the case of
a plan that provides dental benefits through a network of
providers, the plan shall--
``(A) permit a participant or beneficiary to
designate payment of dental benefits to a provider who
is not participating in the network;
``(B) provide the same dollar amount of coverage
for a given procedure regardless of whether the
provider of the procedure is participating in the
network; and
``(C) not permit the application of the plan's or
network's fee schedule to services for which no
benefits or reimbursement are provided.
``(c) Transparency.--In order to ensure transparency in the
provision of dental benefits to participants and beneficiaries in a
group health plan, the plan shall meet the following requirements:
``(1) Prohibition of bundling and down coding.--The plan
shall not--
``(A) systematically combine distinct dental
procedures codes in a manner that results in a reduced
benefit under the plan; or
``(B) provide for a change in the benefit code to a
less complex (or lower cost) procedure than was
reported if such actions are inconsistent with the
current dental terminology (CDT) or, for a provider
participating in a network, inconsistent with the terms
of the network participation agreement.
``(2) Fair payment terms.--The plan shall--
``(A) provide for payment of interest (at a rate
specified by the Secretary) or other penalty for clean
claims paid more than 30 days after the date of their
submission;
``(B) not seek collection of overpayments more than
90 days after the date of the overpayment; and
``(C) not recover overpayments for a dental
procedure by withholding payments for unrelated
procedures.
``(3) Transparency in use of lease networks.--A plan may
use a network that is leased by a health insurance issuer or
other entity to another such issuer or entity (where such
leasing is permitted by the contract between a provider and the
issuer or other entity) only if the contract language describes
in a manner understandable to the average dental provider the
terms of such leasing,''.
(b) Conforming Amendment.--The table of contents of such Act is
amended by inserting after the item relating to section 715 the
following new item:
``Sec. 716. Value and transparency requirements for dental benefits.''.
(c) Effective Date.--The amendments made by this section shall
apply to plan years beginning more than 1 year after the date of the
enactment of this Act.
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Introduced in House
Introduced in House
Referred to the House Committee on Education and Labor.
Referred to the Subcommittee on Health, Employment, Labor, and Pensions.
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