BILL NUMBER:A10755
TITLE OF BILL: An act to amend the insurance law, in relation to coor-
dination of benefits among dental health plans
PURPOSE OR GENERAL IDEA OF BILL: Requires that dental. health and
dental insurance plans all pay as primary providers under their plans
and that this method of coordination of benefits be clearly explained to
patients.
SUMMARY OF SPECIFIC PROVISIONS: Bill Section 1 would add a new Section
3224-c to the Insurance Law to require that all dental benefit plans pay
benefits without taking into consideration the existence of any other
plan. Benefits would be coordinated with each plan paying as the primary
plan, but with reimbursement capped at the total amount of the dental
claim submitted. This coordination of benefits methodology must be
clearly explained to all covered persons.
Bill Section 2 would provide that the law take effect January 1, 2011.
JUSTIFICATION: Dental benefits do not work well under existing coordi-
nation of benefit rules that try to allocate benefits between primary
and secondary dental benefit plans. The methodology for coordinating
dental benefits that this bill would implement parallels the system used
in California and codifies and makes exclusive one of the mechanisms
that is permitted now under regulations of the New York State Department
S T A T E O F N E W Y O R K
________________________________________________________________________
10755
I N A S S E M B L Y
April 20, 2010
___________
Introduced by M. of A. ABBATE -- read once and referred to the Committee
on Insurance
AN ACT to amend the insurance law, in relation to coordination of bene-
fits among dental health plans
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. The insurance law is amended by adding a new section 3224-d
to read as follows:
S 3224-D. COORDINATION OF DENTAL BENEFITS. EVERY HEALTH INSURANCE
PLAN, MANAGED CARE HEALTH PLAN, HEALTH MAINTENANCE ORGANIZATION, OR ANY
OTHER PLAN OF ANY TYPE AUTHORIZED UNDER THIS ARTICLE, ARTICLE FORTY-TWO,
FORTY-THREE OR FORTY-EIGHT OF THIS CHAPTER, OR ANY OTHER ARTICLE OR
PROVISION OF THIS CHAPTER, OR UNDER ARTICLE FORTY-FOUR OF THE PUBLIC
HEALTH LAW OR ANY OTHER ARTICLE OR PROVISION OF THE PUBLIC HEALTH LAW,
OR SECTION THREE HUNDRED SIXTY-FOUR-J OF THE SOCIAL SERVICES LAW OR ANY
OTHER PROVISION OF THE SOCIAL SERVICES LAW, INCLUDING ANY GOVERNMENTAL
PLAN, WHETHER AUTHORIZED UNDER ANY FEDERAL OR STATE LAW, SHALL DETERMINE
AND PAY ITS BENEFITS FOR A PERSON'S DENTAL HEALTH CARE COVERAGE WITHOUT
TAKING THE EXISTENCE OF ANY OTHER PLAN INTO CONSIDERATION. NO PERSON
SHALL BE ENTITLED TO BE PAID MORE THAN THE TOTAL AMOUNT OF THE CLAIM
SUBMITTED PURSUANT TO THIS SECTION. EVERY PLAN COVERED BY THIS SECTION
SHALL EXPLAIN IN CLEAR, PLAIN, APPROPRIATE LANGUAGE TO ALL PERSONS
COVERED BY THE PLAN THE COORDINATION OF BENEFIT RULES REQUIRED BY THIS
SECTION, AND SHALL CONSULT IN ADVANCE WITH THE NEW YORK STATE DENTAL
ASSOCIATION ON SUCH APPROPRIATE LANGUAGE.
S 2. This act shall take effect January 1, 2011.
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD16865-01-0
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