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- Alaska Statutes.
- Title 21. Insurance
- Chapter 42. The Insurance Contract
- Section 392. Requirements Relating to Dental Care Coverage Provisions.
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AS 21.42.392. Requirements Relating to Dental Care Coverage Provisions.
- (a) A health care insurer who provides coverage for dental care may not include in the health care insurance plan or
contract a provision that
- (1) prohibits a covered person from obtaining dental care services from a dentist of the person's choice, including a
- (2) restricts a covered person's right to receive full information from the person's dentist regarding the care or
treatment options that the dentist believes are in the best interests of the person.
- (b) A health care insurance plan or contract that provides coverage for dental services that allows the health care
insurer to review a treatment plan or conduct a utilization review must contain a provision that a treatment plan
review or utilization review relating to dental care for a covered person receiving treatment in this state must be
conducted by a dentist if the claim for reimbursement or payment is denied.
- (c) A health care insurer may reimburse a covered person at a different rate because of the person's choice of a dentist
if the dentist is not a part of the covered person's dental network or preferred provider organization agreement. The
covered expense for non-network providers may not be less than that allowed to a network provider, although the covered
expense may be reimbursed at a lower percentage or with higher deductibles than if the service had been provided within
- (d) A health care insurer may not deny
- (1) dental coverage, cancel a health care insurance plan or contract, or otherwise take action against a covered person or
a dentist because the person has asserted a right described in this section;
- (2) dental coverage or eligibility for dental coverage because the covered person chooses a dentist outside of a preferred
provider organization agreement.
- (e) A covered person may bring a civil action against a health care insurer to enforce the person's rights under this
section if the covered person has exhausted the administrative appeal process.
- (f) A dentist who treats a covered person may not waive uncovered dental expenses for which the covered person has
liability because a covered person chose the dentist outside of a dental network or a preferred provider organization
- (g) In this section,
- (1) "covered expense" means charges that are payable under plan provisions;
- (2) "dentist" means a person licensed in this state to practice dentistry;
- (3) "preferred provider" means a dental provider who has signed an agreement with a dental care plan to provide services
to plan participants at a specific rate.
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