HOUSE BILL REPORT

SHB 1002

This analysis was prepared by non-partisan legislative staff for the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it constitute a statement of legislative intent.

As Passed Legislature

Title: An act relating to prohibiting unfair and deceptive dental insurance practices.

Brief Description: Prohibiting unfair and deceptive dental insurance practices.

Sponsors: House Committee on Health Care & Wellness (originally sponsored by Representative DeBolt).

Brief History:

Committee Activity:

Health Care & Wellness: 2/4/15, 2/13/15 [DPS].

Floor Activity:

Passed House: 3/2/15, 97-0.

Passed Senate: 4/9/15, 45-0.

Passed Legislature.

Brief Summary of Substitute Bill

  • Prohibits dental-only plans from denying coverage for emergency dental conditions on the basis that they are provided on the same day the patient was examined and diagnosed for the conditions.

  • Requires dental-only plans to submit certain information to the Office of the Insurance Commissioner.

HOUSE COMMITTEE ON HEALTH CARE & WELLNESS

Majority Report: The substitute bill be substituted therefor and the substitute bill do pass. Signed by 15 members: Representatives Cody, Chair; Riccelli, Vice Chair; Schmick, Ranking Minority Member; Harris, Assistant Ranking Minority Member; Caldier, Clibborn, DeBolt, Jinkins, Johnson, Moeller, Robinson, Rodne, Short, Tharinger and Van De Wege.

Staff: Jim Morishima (786-7191).

Background:

Health carriers enter into contracts with health care providers under which the providers agree to accept a specified reimbursement rate for their services. Health carriers require prior authorization for certain health procedures. Prior authorization is the requirement that a health care provider seek approval of a drug, procedure, or test before seeking reimbursement from an insurer.

A health carrier offering a health benefit plan must annually submit certain data to the Office of the Insurance Commissioner (OIC), including:

The OIC must make this information available to the public through a searchable public website.

Summary of Substitute Bill:

Emergency Dental Conditions.

A health carrier offering a dental-only plan may not deny coverage for treatment of an emergency dental condition that would otherwise be considered a covered service of an existing benefit contract on the basis that the service was provided on the same day the covered person was examined and diagnosed for the emergency dental condition.

An emergency dental condition is a dental condition manifesting itself by acute symptoms of sufficient severity that a prudent layperson possessing an average knowledge of health and dentistry could reasonably expect the absence of immediate dental attention to result in:

Dental Only Plan Reporting.

A health carrier offering a dental-only plan must annually submit the following data to the OIC on an aggregate level:

The OIC must make this information available to the public through a searchable public website.

Appropriation: None.

Fiscal Note: Available.

Effective Date: The bill takes effect on January 1, 2017.

Staff Summary of Public Testimony:

(In support of substitute bill) This is a patient advocacy bill. Patients care about every benefit dollar and can struggle when care is not covered. In emergencies, dentists assess the patient first. If definitive care is provided the same day, insurance carriers often deny reimbursement. Dentists often absorb the costs of this care. This bill will require dental-only carriers to disclose their medical loss ratios. This bill has been negotiated among the stakeholders.

(In support with concerns on substitute bill) A dental-only carrier's medical loss ratio should be reported company-wide, not by line of business.

(Opposed) None.

Persons Testifying: (In support of substitute bill) Representative DeBolt, prime sponsor; Amy Cook; Bracken Killpack, Washington State Dental Association; Sean Pickard, Delta Dental of Washington; and Melissa Johnson, Willamette Dental Group.

(In support with concerns on substitute bill) Len Sorrin, Premera Blue Cross; and Chris Bandoli, Regence Blue Shield.

Persons Signed In To Testify But Not Testifying: None.