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Bill

SB 2887

AN ACT RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES-DENTAL INSURANCE COVERAGE

2026 Regular Session Introduced by John Burke and 4 co-sponsors

Requires insurers to pay benefits directly to any credentialed non-contracted dental provider chosen by the insured, at parity with the highest contracted payments.

05/05/2026 Committee recommended measure be held for further study
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WeVote Research Nonpartisan
Bill Summary · SB 2887

Summary of Bill SB 2887 (Rhode Island, 2026)

Intent and Purpose

  • The act aims to clarify and standardize how dental insurance benefits are paid when a dental care provider is selected by the insured, including providers who are not contracted with the insurer.
  • It seeks to ensure direct payment to the dental provider by the insurer, with minimum reimbursement benchmarks, and to prohibit reductions based on the provider’s participation status.
  • Effective date: January 1, 2027.

Key Provisions

1) Dental Insurance Assignment of Benefits (Sections 27-18-63; 27-19-54; 27-41-66)

  • Every insurer operating under accident and sickness insurance, nonprofit hospital service corporations, and health maintenance organizations must allow an insured to direct, in writing, that benefits be paid directly to a dental care provider who:
    • May not be contracted with the entity,
    • Meets the entity’s credentialing criteria, and
    • Has not been previously terminated as a participating provider.
  • When a valid written direction to pay is provided, the insurer must pay benefits directly to the designated dental provider.
  • The payment to the non-contracted provider may be reduced by no more than 5% (relative to what is paid to participating dentists). Insurers may review the provider’s records related only to the specific subscriber/patient to verify services rendered.
  • The insurer must pay benefits so that the amount is not less than the highest reimbursed amount actually paid to any participating provider for the same covered dental service, according to the insurer’s benefit tables or fee schedules, including incentive-based or tiered schedules.
  • If multiple tiers/schedules exist, the benchmark is the highest reimbursement amount listed for the procedure code among all participating categories.
  • Insurers may not use tiered reimbursement structures, geographic modifiers, or network classifications to reduce the benchmark amount, nor create new provider categories or payout tiers for the purpose of reducing the benchmark.
  • The benefit amount cannot be reduced, modified, or conditioned based on the provider’s non-participation status.
  • Exceptions: The act does not apply to certain limited-benefit policies (e.g., hospital confinement indemnity, disability income, accident-only, long-term care, etc.).

2) Consent and Verification

  • Upon receipt of a duly executed written direction to pay and notice thereof, the insurer must pay the dental provider directly.
  • The insurer may review the dental provider’s records related exclusively to the subscriber/patient to verify that the service was rendered and meets payment criteria.

Affected Entities and Parties

  • Insurance entities providing:
    • Accident and sickness policies (including dental coverage riders),
    • Nonprofit hospital service corporations,
    • Health Maintenance Organizations (HMOs).
  • Insured individuals seeking dental services.
  • Dental care providers (contracted or non-contracted) who meet credentialing criteria and have not been terminated as participating providers.

Procedural and Timeline Aspects

  • Effective date: January 1, 2027.
  • Requires insurers to implement procedures for:
    • Accepting and processing written directions to pay to non-contracted providers,
    • Verifying services rendered through limited record review,
    • Ensuring payment benchmarks align with the highest amounts paid to participating providers.

Summary of Impact

  • Expands insureds’ ability to direct benefits to any credentialed dental provider (not just contracted ones).
  • Seeks to protect insured access to dental care by ensuring direct payment sufficiency and parity with payments to participating providers.
  • Limits insurer discretion to reduce payment amounts via tiered structures or network changes when paying non-contracted providers.
  • Establishes a uniform framework across multiple Rhode Island insurance entities for dental benefit assignments.

If you’d like, I can provide a side-by-side comparison with current Rhode Island law or potential practical scenarios illustrating how the payment calculations would work.

Compiled from official sources — confirm details with the bill’s official record.

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