Alabama § 27-19A-12 - Dental Services - Coverages; Fees; Exceptions.

§ 27-19A-12. Dental Services - Coverages; Fees; Exceptions.

(a) As used in this section, the following terms shall have the following meanings:

(1) COVERED PERSON. Any individual, family, or family member on whose behalf third-party payment or prepayment of health or medical expenses is provided under an insurance policy, plan, or contract providing for third-party payment or prepayment of health care or medical expenses.

(2) COVERED SERVICES. Dental care services for which a reimbursement is available under an enrollee’s plan contract, or for which a reimbursement would be available but for the application of contractual limitations such as deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums, frequency limitations, alternative benefit payments, or any other limitation.

(3) DENTAL CARE PROVIDER. A licensed dentist.

(4) DENTAL PLAN. Includes any policy of insurance which is issued by a health care service contractor which provides for coverage of dental services not in connection with a medical plan.

(5) INSURANCE POLICY, PLAN, OR CONTRACT PROVIDING FOR THIRD-PARTY PAYMENT OR PREPAYMENT OF HEALTH OR MEDICAL EXPENSES. Includes an individual or group policy for accident or health insurance, an individual or group hospital or health care service contract, an individual or group health maintenance organization contract, an organized delivery system contract, a preferred provider organization contract, and any other similar policy, plan, or contract.

(b) An insurance policy, plan, or contract providing for third-party payment or prepayment of health or medical expenses issued after January 1, 2016, shall not require a dental care provider to provide service to a covered person at a fee set by the policy or plan unless the services are covered by the policy or plan.

(c) Nothing in this section shall be construed as limiting the ability of an insurer or a third-party administrator to restrict any of the following as related to covered services:

(1) Balance billing.

(2) Waiting periods.

(3) Frequency limitations.

(4) Deductibles.

(5) Maximum annual benefits.

(d) Nothing in this section shall apply to corporations organized pursuant to Article 6, commencing at Section 10A-20-6.01, of Chapter 20 of Title 10A, or to policies, plans, or contracts entered, issued, or administered by the corporations.