NC S252

Prohibits insurers from requiring dentists to provide non-covered services at plan-set fee limits, unless those services are reimbursed as covered services under the contract.

Bans restrictions that require dental providers to accept credit card payments as the only acceptable payment method from insurers.

Requires insurers to allow individual dental providers to opt out of third-party access to their provider networks at contract entry and renewal, with third-party access clearly identified in contracts.

Mandates insurers list all third parties granted access to their provider networks on their websites and requires third parties to comply with all provider network contract terms.

Prohibits insurers from retracting coverage determinations or reducing payments after services are provided, except when the determination was based on material misrepresentation about the insured's health condition.

Clarifies that pretreatment estimates for dental services are voluntary benefit projections that do not constitute coverage determinations.

Effective January 1, 2020, for health benefit contracts issued, renewed, or amended on or after that date.