SB154 Alabama 2011 Session

Summary

Primary Sponsor

Paul Bussman

Republican

Session

Regular Session 2011

Title

Dental services, certain health insurance policies and health maintenance organizations plans, setting fees for services not covered by the plan, prohibited

Summary

SB154 limits health plans from forcing dentists to charge plan-set fees for dental services unless the service is actually covered by the plan, and clarifies billing rules for covered and non-covered services.

What This Bill Does

If a health policy or plan covers a dental service, the plan may set terms for that service. The bill prohibits requiring a dentist to provide services to a covered person at a fee set by the plan unless the service is covered, and it clarifies that for non-covered services the plan cannot force the dentist to charge its fee. The bill keeps existing limits on balance billing, waiting periods, frequency limits, deductibles, and maximum benefits, and it defines key terms. It becomes law on the first day of the third month after it is passed and approved by the Governor.

Who It Affects

• Covered individuals (patients) with dental coverage, who are protected from being charged plan-set fees for non-covered dental services.
• Licensed dentists and dental care providers, and the insurers/plans offering dental coverage, who must follow the rule that non-covered services cannot be billed at a plan-set fee and that terms for covered services may be governed by the policy.

Key Provisions

• Section 2: A health insurance policy, plan, or contract providing third-party payment or prepayment of health expenses shall not require a dental care provider to provide service to a covered person at a fee set by the policy unless the services are covered by the policy.
• Section 1: Definitions of Covered Person, Dental Care Provider, and Insurance Policy/Plan/Contract Providing for Third-Party Payment or Prepayment of Health or Medical Expenses.
• Section 3: The act does not limit the insurer's ability to restrict balance billing, waiting periods, frequency limitations, deductibles, or maximum annual benefits.
• Section 4: Effective date is the first day of the third month following passage and Governor approval.

AI-generated summary using openai/gpt-5-nano on Feb 25, 2026. May contain errors — refer to the official bill text for accuracy.

Subjects

Health