2019 legislative report

AzDA strengthened payment protections and expanded practice flexibility

During the 2019 legislative session, AzDA helped secure stronger protections regarding insurer payments and provider-network leasing, while establishing a clear legal framework for dental membership plans.

Payment choice Network transparency Dental membership plans Practice autonomy
2 major AzDA-supported bills enacted
3 insurance and contracting protections created
1 legal framework created for dental membership plans
2020 effective year for key payment protections
Featured insurance reform

The law prevents insurer contracts from requiring providers to accept credit card payments as the only payment method. It also requires clear disclosure of fees and available alternatives when insurers use electronic funds transfers or virtual credit cards.

Payment-method choice Fee disclosure Clear opt-out instructions
Insurance reform

More control over payments and provider-network contracts

HB2494 addressed two recurring practice-management concerns: costly virtual credit card payments and the sale or lease of provider networks without adequate notice.

2 protections
HB2494

Virtual credit card and payment-method protections

Signed into law
Practice impact

Insurer contracts issued, amended, or renewed after January 1, 2020, may not restrict providers to credit card payments as the only payment option.

  • Insurers must disclose fees associated with electronic or virtual credit card payments.
  • Providers must be informed of which alternative payment methods are available.
  • Insurers must provide clear instructions for selecting another payment method.
  • Every payment must be associated with an explanation of benefits.
HB2494

Provider-network leasing transparency

Signed into law
Practice impact

When an insurer sells or leases a provider network, the contracting insurer must notify participating providers that another insurer has acquired access to the network.

Continue

A dentist may continue with the acquiring insurer under the terms of the existing agreement.

Terminate

A dentist may end the relationship in accordance with the termination requirements in the original contract.

Renegotiate

A dentist may enter a new agreement with the acquiring insurer and negotiate different contract terms.

Review contracts

Existing contracts should be reviewed for provisions that already authorize network sales or leasing.

Contract caution

The protections may not override network-leasing terms that were clearly disclosed and accepted in the provider's original agreement.

Practice flexibility

A legal framework for in-house dental membership plans

SB1105 created a statutory safe harbor for direct primary care agreements, including those covering dental services, without treating such arrangements as insurance products.

1 new framework
SB1105

Direct primary care and dental membership agreements

Signed into law
Practice impact

Dentists gained a clearer legal framework for offering in-house membership agreements without those arrangements being regulated as prepaid dental insurance.

Required agreement terms

  • The agreement must be written and signed by the provider and the patient or the patient's legal representative.
  • It must describe the covered services, periodic fee, additional charges, duration, and renewal terms.
  • Either party generally may terminate the agreement with 30 days' written notice.
  • The agreement must clearly state that it is not an insurance policy.
  • Prepayment may not exceed 12 months of periodic fees.
Operational safeguards
  • Comparable services may not be priced differently based on a patient's health status or gender.
  • A provider may not submit insurance claims for services already covered by the membership agreement.
  • Unused prepaid fees must be refunded after termination.
  • Dental services covered by the agreement must remain within a single practice.
Required patient disclosure

The agreement must clearly state that the arrangement is not health insurance, does not replace insurance coverage, and does not eliminate the patient's responsibility for healthcare expenses outside the agreement.

Practical advocacy for dental practices

AzDA helped dentists gain more control over contracts, payments, and practice models

These reforms addressed real administrative and financial problems facing dental offices while giving practices additional options for serving patients outside traditional insurance arrangements.

Learn more about advocacy Join or renew with AzDA