20-1057.12. Contracts; dentists; covered services; definition

A. A contract, entered into or renewed on or after January 1, 2011, between a health care services organization and a dentist who is licensed to practice in this state shall not require the dentist to provide services to an individual covered under an evidence of coverage based on a fee set by the health care services organization unless the services for which the fee applies is a covered service under the individual's evidence of coverage.

B. This section does not restrict the ability of a health care services organization to establish dental benefits for services offered by plans that are administered but not insured by the health care services organization.

C. For the purposes of this section, "covered service" means a service for which any reimbursement is available under an evidence of coverage without regard to contractual limitations by a deductible, copayment, coinsurance, waiting period, annual or lifetime maximum, frequency limitation, alternative benefit payment, exclusion or other limitation.

20-1057.12. Contracts; dentists; covered services; definition

A. A contract, entered into or renewed on or after January 1, 2011, between a health care services organization and a dentist who is licensed to practice in this state shall not require the dentist to provide services to an individual covered under an evidence of coverage based on a fee set by the health care services organization unless the services for which the fee applies is a covered service under the individual's evidence of coverage.

B. This section does not restrict the ability of a health care services organization to establish dental benefits for services offered by plans that are administered but not insured by the health care services organization.

C. For the purposes of this section, "covered service" means a service for which any reimbursement is available under an evidence of coverage without regard to contractual limitations by a deductible, copayment, coinsurance, waiting period, annual or lifetime maximum, frequency limitation, alternative benefit payment, exclusion or other limitation.