SENATE BILL 260

50th legislature - STATE OF NEW MEXICO - first session, 2011

INTRODUCED BY

Kent L. Cravens

AN ACT

RELATING TO INSURANCE; ENACTING A NEW SECTION OF THE NEW MEXICO INSURANCE CODE TO PROHIBIT A DENTAL INSURANCE PLAN FROM REQUIRING A DENTIST TO ACCEPT A FEE SET BY THE PLAN FOR SERVICES NOT COVERED BY THE PLAN; DECLARING AN EMERGENCY.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

     SECTION 1. A new section of the New Mexico Insurance Code is enacted to read:

     "[NEW MATERIAL] DENTAL INSURANCE PLAN--DENTAL FEES NOT COVERED--SEVERABILITY.-- 

          A. As used in this section:

                (1) "covered services" means 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; and

                (2) "dental insurance plan" means any policy of insurance that is issued by a health care service contractor that provides for coverage of dental services not in connection with a medical plan.

          B. No contract of any health care service contractor that covers any dental services and no contract or participating provider agreement with a dentist shall require, directly or indirectly, that a dentist who is a participating provider provide services to an enrolled participant at a fee set by, or at a fee subject to the approval of, the health care service contractor unless the dental services are covered services.

          C. A health care service contractor or other person providing third party administrator services shall not make available any providers in its dentist network to a plan that sets dental fees for any services except covered services.

          D. If any part or application of this section is held invalid, the remainder or its application to other situations or persons shall not be affected."

     SECTION 2. EMERGENCY.--It is necessary for the public peace, health and safety that this act take effect immediately.

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