§ 27-18-63 - Dental insurance assignment of benefits. - Rhode-island Statutes

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Statutes > Rhode-island > Title-27 > Chapter-27-18 > 27-18-63

SECTION 27-18-63

§ 27-18-63 Dental insurance assignment ofbenefits. – Every entity providing a policy of accident and sickness insurance as definedin this chapter shall allow, as a provision in a group or individual policy,contract or health benefit plan for coverage of dental services, any personinsured by such entity to direct, in writing, that benefits from a healthbenefit plan, policy or contract, be paid directly to a dental care providerwho has not contracted with the entity to provide dental services to personscovered by the entity but otherwise meets the credentialing criteria of theentity and has not previously been terminated by such entity as a participatingprovider. If written direction to pay is executed and written notice of thedirection to pay is provided to such entity, the insuring entity shall pay thebenefits directly to the dental care provider. Any efforts to modify the amountof benefits paid directly to the dental care provider under this section mayinclude a reduction in benefits paid of no more than five percent (5%) lessthan the benefits paid to participating dentists. The entity paying thedentist, pursuant to a direction to pay duly executed by the subscriber, shallhave the right to review the records of the dentist receiving such payment thatrelate exclusively to that particular subscriber/patient to determine that theservice in question was rendered. Provided, however, this section shall notapply to insurance coverage providing benefits for:

(1) Hospital confinement indemnity;

(2) Disability income;

(3) Accident only;

(4) Long-term care;

(5) Medicare supplement;

(6) Limited benefit health;

(7) Specified disease indemnity;

(8) Sickness or bodily injury or death by accident or both;and

(9) Other limited benefit policies.

State Codes and Statutes

Statutes > Rhode-island > Title-27 > Chapter-27-18 > 27-18-63

SECTION 27-18-63

§ 27-18-63 Dental insurance assignment ofbenefits. – Every entity providing a policy of accident and sickness insurance as definedin this chapter shall allow, as a provision in a group or individual policy,contract or health benefit plan for coverage of dental services, any personinsured by such entity to direct, in writing, that benefits from a healthbenefit plan, policy or contract, be paid directly to a dental care providerwho has not contracted with the entity to provide dental services to personscovered by the entity but otherwise meets the credentialing criteria of theentity and has not previously been terminated by such entity as a participatingprovider. If written direction to pay is executed and written notice of thedirection to pay is provided to such entity, the insuring entity shall pay thebenefits directly to the dental care provider. Any efforts to modify the amountof benefits paid directly to the dental care provider under this section mayinclude a reduction in benefits paid of no more than five percent (5%) lessthan the benefits paid to participating dentists. The entity paying thedentist, pursuant to a direction to pay duly executed by the subscriber, shallhave the right to review the records of the dentist receiving such payment thatrelate exclusively to that particular subscriber/patient to determine that theservice in question was rendered. Provided, however, this section shall notapply to insurance coverage providing benefits for:

(1) Hospital confinement indemnity;

(2) Disability income;

(3) Accident only;

(4) Long-term care;

(5) Medicare supplement;

(6) Limited benefit health;

(7) Specified disease indemnity;

(8) Sickness or bodily injury or death by accident or both;and

(9) Other limited benefit policies.

State Codes and Statutes

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State Codes and Statutes

Statutes > Rhode-island > Title-27 > Chapter-27-18 > 27-18-63

SECTION 27-18-63

§ 27-18-63 Dental insurance assignment ofbenefits. – Every entity providing a policy of accident and sickness insurance as definedin this chapter shall allow, as a provision in a group or individual policy,contract or health benefit plan for coverage of dental services, any personinsured by such entity to direct, in writing, that benefits from a healthbenefit plan, policy or contract, be paid directly to a dental care providerwho has not contracted with the entity to provide dental services to personscovered by the entity but otherwise meets the credentialing criteria of theentity and has not previously been terminated by such entity as a participatingprovider. If written direction to pay is executed and written notice of thedirection to pay is provided to such entity, the insuring entity shall pay thebenefits directly to the dental care provider. Any efforts to modify the amountof benefits paid directly to the dental care provider under this section mayinclude a reduction in benefits paid of no more than five percent (5%) lessthan the benefits paid to participating dentists. The entity paying thedentist, pursuant to a direction to pay duly executed by the subscriber, shallhave the right to review the records of the dentist receiving such payment thatrelate exclusively to that particular subscriber/patient to determine that theservice in question was rendered. Provided, however, this section shall notapply to insurance coverage providing benefits for:

(1) Hospital confinement indemnity;

(2) Disability income;

(3) Accident only;

(4) Long-term care;

(5) Medicare supplement;

(6) Limited benefit health;

(7) Specified disease indemnity;

(8) Sickness or bodily injury or death by accident or both;and

(9) Other limited benefit policies.