HB 497 Summary

• Prohibits health insurers from setting or requiring approval of fees for dental services not covered under a health benefit plan contract, or offering plans that set fees for non-covered dental services.

• Defines "covered dental services" as dental services with reimbursement available under an enrollee's plan (accounting for deductibles, copayments, and other limitations) where the reimbursement exceeds 50% of the provider's prevailing fee.

• Requires contracting entities to disclose comprehensive information to participating dental providers before contract execution, including compensation terms, fee schedules, payment methodology, and internal dispute resolution procedures.

• Exempts health benefit plans subject to the federal Employee Retirement Income Security Act (ERISA) from the dental service fee restrictions.

• Adds unfair and deceptive insurance practice prohibitions under Ohio law regarding improper dental fee schedules and reimbursement practices for non-covered dental services.