This bill amends Minnesota Statutes 2024, section 62Q.78, subdivision 6 to modify the definition of covered services for dental care and regulate how dental service fees are determined under insurance contracts.

Key Provisions:
1. Fee Restrictions – Dental plans or organizations cannot require dentists to charge set fees for services unless those services are covered by the plan.
2. Network Access – A dental plan or third-party administrator cannot make its dentist network available to plans that set dental fees for non-covered services.
3. Definition of Covered Services – A covered service includes dental care services for which reimbursement is available under an enrollee’s plan or would be available if not for specific contractual limitations (e.g., deductibles, copayments, waiting periods, or maximums).
4. Limits on Charges for Non-Covered Services – A dentist may not charge more than their usual and customary rate for procedures not covered by insurance.
5. Transparency for Patients – Before providing non-covered services, a dentist must give the patient a treatment plan outlining expected procedures and estimated costs.
6. Plan Limitations Remain – The bill does not prevent dental plans from enforcing restrictions such as balance billing, waiting periods, frequency limits, deductibles, or maximum benefits on covered services.

Purpose:

The bill aims to clarify billing practices in dental insurance, ensuring transparency for patients while restricting insurance plans from setting fees for procedures they do not cover.