WILLIAM DONALD SCHAEFER, Governor

AN ACT concerning

Insurance - Dental Plans

FOR the purpose of requiring that dental plans provide for
payments to certain dentists in certain amounts for certain
dental services; defining certain terms; providing that a
dental plan is not responsible for the quality of care
provided by certain persons; providing for the applicability
of this Act; and generally relating to dental plans under
the insurance law.

BY adding to

Article 48A - Insurance Code

Section 581(g) and (h) and 597A

Annotated Code of Maryland

(1986 Replacement Volume and 1986 Supplement)

SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF
MARYLAND, That the Laws of Maryland read as follows:

Article 48A - Insurance Code

581.

(G) "NONPANEL DENTIST" MEANS ANY DENTIST WHO IS ELIGIBLE
FOR PAYMENT FOR DENTAL SERVICES RENDERED, BUT WHO HAS NOT ENTERED
INTO A CONTRACT WITH A DENTAL PLAN ORGANIZATION TO PROVIDE DENTAL
SERVICES UNDER A DENTAL PLAN.

(H) "PANEL DENTIST" MEANS ANY DENTIST WHO HAS ENTERED INTO
A CONTRACT WITH A DENTAL PLAN ORGANIZATION TO PROVIDE DENTAL
SERVICES UNDER THE TERMS AND CONDITIONS OF A DENTAL PLAN.

597A.

(A)  A DENTAL PLAN OFFERED BY A DENTAL PLAN ORGANIZATION
UNDER THIS SUBTITLE SHALL PROVIDE FOR PAYMENT OF SERVICES
RENDERED BY NONPANEL DENTISTS.

(B)  (1) EXCEPT AS OTHERWISE PROVIDED IN PARAGRAPH (2) OF
THIS SUBSECTION, THE TOTAL AMOUNT OF PAYMENTS MADE TO A NONPANEL
DENTISTS IN ANY FULL CALENDAR YEAR DENTIST UNDER SUBSECTION (A)
OF THIS SECTION, AFTER ALL DEDUCTIBLE AND COPAYMENT PROVISIONS
HAVE BEEN APPLIED, ON THE AVERAGE MAY NOT BE LESS THAN 80
PERCENT OF THE TOTAL AMOUNT OF PAYMENTS MADE TO A PANEL DENTISTS
IN THAT FULL CALENDAR YEAR DENTIST FOR SIMILAR SERVICES IN THE
SAME GEOGRAPHIC AREA.

(2) THE TOTAL AMOUNT OF PAYMENTS MADE TO NONPANEL
DENTISTS MAY DIFFER FROM THE AMOUNT SET FORTH IN SUBSECTION

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