H.R. 1798 — Introduced in House

I 113th CONGRESS 1st Session H. R. 1798 IN THE HOUSE OF REPRESENTATIVES April 26, 2013 Mr. Gosar (for himself, Mr. Simpson, Mr. Andrews, and Mr. Loebsack) introduced the following bill; which was referred to the Committee on Education and the Workforce A BILL To amend the Employee Retirement Income Security Act of 1974 to ensure health care coverage value and transparency for dental benefits under group health plans. 1. Short title This Act may be cited as the Dental Insurance Fairness Act of 2013. 2. Findings Congress finds the following: (1) Dental coverage helps approximately 173 million Americans get the dental care that is vital to ensuring good oral and overall health. (2) Unfair practices of dental benefit plans hinder patients’ ability to receive the full benefits for which they pay and, in some cases, provide the dental insurance industry with windfall profits. (3) The Dental Insurance Fairness Act of 2013 will help consumers receive the full value of their dental coverage. 3. Value requirements for dental benefits Subpart B of part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185 et seq.) is amended by adding at the end the following: 716. Value requirements for dental benefits (a) In general The requirements of this section shall apply to self-insured group health plans insofar as they provide dental benefits (including, notwithstanding section 732(c)(1), self-insured limited scope dental benefits (described in section 733(c)(2))). (b) Value In order to ensure that participants and beneficiaries in a group health plan receive full value from dental benefits, the plan shall meet the following requirements: (1) Uniform coordination of benefits The plan shall provide for coordination of benefits in a manner so that the plan pays the same amount regardless of other coverage for such benefits so long as the total amount paid does not exceed 100 percent of the amount of the applicable claim. Such coordination shall be effected consistent with such rules as the Secretary establishes, based upon similar model regulations developed by the National Association of Insurance commissioners. (2) Equity for dental patients through assignment of benefits In the case of a plan that provides dental benefits through a network of providers, the plan shall permit a participant or beneficiary to designate payment of dental benefits to a provider who is not participating in the network. .