This bill adds a new section to federal law about dental and vision coverage. It says that for group or individual health plans, including limited-scope dental or vision plans, certain rules apply to dentists, optometrists, and entities that employ them. Key rules: providers who have an agreement with a plan may charge an enrollee for items or services the plan does not cover up to the provider's usual and customary amount charged to non-enrollees; dental cleanings must be charged only at the contracted network fee even if they go over the plan's annual maximum; plans cannot restrict which laboratory or supplier a provider uses for items and services within the provider's scope of practice. For limited-scope plan contracts, extending an agreement beyond 2 years requires the provider's prior acceptance for each extension. The bill also requires the federal Secretary to annually ask each State whether the State will enforce these rules; if a State declines or does not reply within 90 days, the Secretary will treat the State as not substantially enforcing the rules for certain enforcement provisions. Providers may elect to have some of the bill's payment and laboratory-choice requirements not apply to a plan for a single plan year (with possible yearly renewals), but this election cannot be used to change the rules about contract duration for limited-scope plans. The bill adds definitions for covered services and for the types of dental and optometry doctors. It also says that State law that directly affects standards for insurers and dental or vision benefit plans still applies and can override these changes where it conflicts.
No publicly available information about proponents' statements or arguments is included in the bill text.
No publicly available information about opponents' statements or arguments is included in the bill text.