31A-22-646. Dental insurance -- Contract provision for noncovered services.

339 words·~2 min read·/ut/title-31a/chapter-22/31a-22-646

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

Effective 5/6/2026

(1)For purposes of this section:

(a)"Covered services" means dental services for which reimbursement:

(i)is available or would be reimbursable under an enrollee's dental plan but for the application of one or more of the following contractual provisions:

(A)deductibles;

(B)copayments;

(C)coinsurance;

(D)waiting periods;

(E)annual or lifetime maximums;

(F)frequency limitations; or

(G)alternative benefit payments; and

(ii)is not merely nominal, for the purpose of avoiding the requirements of this section.

(b)"Dental plan" means:

(i)a health benefit plan that includes coverage for dental services; and

(ii)a policy or certificate that provides coverage solely for dental services.

(c)"Dental provider" means an individual licensed under Title 58, Chapter 69, Dentist and Dental Hygienist Practice Act .

(a)This section applies to:

(i)a dental plan that is entered into or renewed on or after January 1, 2018; and

(ii)an administrator providing third-party administration services or a provider network for a dental plan.

(b)This section does not apply to a self-insured dental plan that is regulated by federal law.

(3)A contract between a dental plan and a dentist to provide covered services may not:

(a)require, directly or indirectly, that a dentist provide dental services to a covered individual at a fee set by, or a fee subject to the approval of, the dental plan unless:

(i)the dental services are covered services under the dental plan; or

(A)the dental services are not reimbursed by the dental plan;

(B)the dental services are discounted for individuals who are part of a discount dental rates plan; and

(C)the dentist who provided the dental services has elected to participate in the discount dental rates plan; and

(b)prohibit a dentist from offering or providing noncovered dental services to a covered individual at a fee determined by the dentist and the individual who will receive the noncovered services.

Amended by Chapter 45 , 2026 General Session