BILL ANALYSIS
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|SENATE RULES COMMITTEE | AB 2275|
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THIRD READING
Bill No: AB 2275
Author: Hayashi (D), et al
Amended: 8/17/10 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 8-0, 6/30/10
AYES: Alquist, Strickland, Aanestad, Cedillo, Leno, Negrete
McLeod, Pavley, Romero
NO VOTE RECORDED: Cox
SENATE APPROPRIATIONS COMMITTEE : 9-0, 8/12/10
AYES: Kehoe, Ashburn, Alquist, Corbett, Emmerson, Leno,
Wolk, Wyland, Yee
NO VOTE RECORDED: Price, Walters
ASSEMBLY FLOOR : 71-0, 5/10/10 - See last page for vote
SUBJECT : Dental coverage: noncovered benefits
SOURCE : Author
DIGEST : This bill prohibits a contract between a health
care service plan, a specialized health care service plan,
or an insurer and a dentist from requiring a dentist to
accept a payment amount set by the plan for dental care
services provided to an enrollee, but that are not covered
services under the contract, commencing with provider
contracts issued, revised, or renewed on or after January
1, 2011.
CONTINUED
AB 2275
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2
ANALYSIS : Under existing law, the Department of Managed
Health Care and the Department of Insurance are responsible
for the licensure and regulation of health care service
plans and insurers, respectively. Existing law requires
contracts between plans or insurers and providers to be
fair and reasonable and the Office of Patient Advocate
within the Department of Managed Health Care to represent
the interests of enrollees served by health care service
plans regulated by the department.
This bill prohibits a contract between a health care
service plan, a specialized health care service plan, or an
insurer and a dentist from requiring a dentist to accept a
payment amount set by the plan for dental care services
provided to an enrollee, but that are not covered services
under the contract. This bill also prohibits a provider
from charging more for dental services that are not covered
services under the contract or policy than his or her usual
and customary rate for those services. This bill applies
to provider contracts that are issued, revised, or renewed
on or after January 1, 2011.
This bill requires that health plan contracts and health
insurance policies that are issued, amended, or renewed on
or after July 1, 2011, include in their evidence of
coverage and disclosure forms a notice that would inform
enrollees and policyholders that a dentist may charge him
or her his or her usual and customary rate for services not
covered by the contract or policy and would direct
enrollees and policyholders to call their plan or insurer's
member services or insurance broker, if they wanted more
information about their dental coverage options.
This bill provides that prior to providing a patient with
dental services that are not a covered benefit, the dentist
should provide to the patient a treatment plan that
includes each anticipated service to be provided and the
estimated cost of each service.
This bill encourages individuals to carefully review their
coverage documents for details about their covered and
non-covered benefits.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
AB 2275
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3
Local: Yes
According to the Senate Appropriations Committee:
Fiscal Impact (in thousands)
Major Provisions 2010-11 2011-12
2012-13 Fund
CDI review dental policies
minor and absorbable Special*
and help-line calls
DMHC oversight and $60 - $70
ongoing unknown, but likely Special**
help center calls minor and absorbable
*Insurance Fund
**Managed Care Fund
ASSEMBLY FLOOR :
AYES: Adams, Ammiano, Anderson, Arambula, Bass, Beall, Bill
Berryhill, Tom Berryhill, Blakeslee, Block, Blumenfield,
Bradford, Brownley, Buchanan, Caballero, Charles
Calderon, Carter, Chesbro, Conway, Cook, Coto, Davis, De
Leon, Emmerson, Eng, Evans, Feuer, Fletcher, Fong,
Fuentes, Fuller, Furutani, Gaines, Galgiani, Garrick,
Gilmore, Hagman, Hall, Hayashi, Hernandez, Hill, Huber,
Huffman, Jeffries, Jones, Knight, Lieu, Logue, Bonnie
Lowenthal, Ma, Miller, Monning, Nestande, Niello,
Nielsen, V. Manuel Perez, Portantino, Ruskin, Salas,
Silva, Skinner, Smyth, Audra Strickland, Swanson,
Torlakson, Torres, Torrico, Tran, Villines, Yamada, John
A. Perez
NO VOTE RECORDED: De La Torre, DeVore, Harkey, Mendoza,
Nava, Norby, Saldana, Solorio, Vacancy
AGB:nl 8/17/10 Senate Floor Analyses
SUPPORT/OPPOSITION: NONE RECEIVED
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