Bill
HB 7722
Rhode Island bill lets insured direct benefits to any credentialed, non-contracted dental provider, with payments at the highest amount paid to participating providers.
Rhode Island Bill HB 7722 (2026) — Dental Insurance: Assignment of Benefits
Purpose and intent
- The bill seeks to clarify and standardize the process by which dental insurance benefits can be paid directly to dental care providers, even if those providers are not contracted with the insurer.
- It applies across multiple insurance contexts: traditional accident and sickness insurers, nonprofit hospital service corporations, and health maintenance organizations (HMOs).
Key provisions and changes
1) Dental assignment of benefits (applicable entities)
- For all entities that provide accident and sickness policies, nonprofit hospital service contracts, and HMO coverage of dental services, the insured may direct in writing that benefits be paid directly to a dental care provider.
- The provider can be a non-contracted dentist who meets the entity’s credentialing criteria and has not been terminated as a participating provider.
- If the insured gives written direction and the insurer receives written notice, the insurer must pay benefits directly to the designated dental provider.
2) Payment amount and benchmarks
- The payment to the non-contracted provider must be at least the highest reimbursement actually paid to any participating provider for the same covered dental service (as listed in the insurer’s benefit tables or fee schedules, including incentive-based or tiered schedules).
- If multiple tiers/schedules exist, the benchmark is the highest amount among all participating provider categories for that service.
3) Protections against reductions via network design
- Insurers may not use tiered reimbursement structures, geographic modifiers, or network classifications to reduce the benchmark amount for this purpose.
- Insurers may not create new provider categories or reimbursement tiers to lower the benchmark amount under this provision.
- The benefit amount cannot be reduced or conditioned based on the provider’s non-participation status, though the insurer may review the provider’s records related to the specific subscriber to verify service and eligibility.
4) Scope and limitations
- The act specifies that the above applies to dental coverage within the specified health benefit plans.
- The statute clarifies that the assignment of benefits does not apply to certain other types of insurance (e.g., hospital confinement indemnity, disability income, accident-only, long-term care, Medicare supplement, etc.).
Effective date
- The act takes effect January 1, 2027.
Who is affected
- Health insurers, nonprofit hospital service corporations, and HMOs that provide dental coverage under Rhode Island law.
- Policyholders who wish to direct benefits to a dental provider not contracted with the insurer.
- Dental providers who are not contracted with the insurer but meet credentialing criteria and have not been terminated as participating providers.
Notes
- The bill reflects a balancing act: expanding patient-directed payment rights while guaranteeing a minimum reimbursement floor (the highest actual payment to participating providers) to protect provider viability.
- Current action history shows committee recommendation to hold for further study, with hearings scheduled earlier in 2026. The text indicates the bill is intended to become law if approved.
Compiled from official sources — confirm details with the bill’s official record.
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