Shown verbatim: the complete text as captured from the official PDF posted by the Maryland General Assembly, fetched 2026-09-25. Page and line markers are part of the official record; nothing is edited or removed. This is the chaptered version. The official bill page.
WES MOORE, Governor Ch. 737
Chapter 737
(Senate Bill 813)
AN ACT concerning
Health Insurance and Dental Plan Organizations – Dentists – Assignment of
Benefits and Reimbursement of Nonpreferred Providers
FOR the purpose of prohibiting certain insurers and dental plan organizations from
prohibiting an assignment of benefits to a provider who is a dentist by an insured or
refusing to directly reimburse a nonpreferred provider who is a dentist; requiring a
nonpreferred provider who is a dentist and who seeks an assignment of benefits from
an insured or enrollee to provide certain information to the insured or enrollee before
performing a health care service and submit a disclosure form to document the
assignment of benefits; authorizing certain insurers and dental plan organizations
to refuse to directly reimburse a nonparticipating provider who is a dentist under
certain circumstances; and generally relating to insurance coverage for dental
services.
BY repealing and reenacting, without amendments,
Article – Insurance
Section 14–201(a)
Annotated Code of Maryland
(2017 Replacement Volume and 2025 Supplement)
BY repealing and reenacting, with amendments,
Article – Insurance
Section 14–201(p) and (r) and 14–205.3
Annotated Code of Maryland
(2017 Replacement Volume and 2025 Supplement)
BY adding to
Article – Insurance
Section 14–410.1
Annotated Code of Maryland
(2017 Replacement Volume and 2025 Supplement)
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND,
That the Laws of Maryland read as follows:
Article – Insurance
14–201.
(a) In this subtitle the following words have the meanings indicated.
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Ch. 737 2026 LAWS OF MARYLAND
(p) “Provider” means a physician, DENTIST, hospital, or other person that is
licensed or otherwise authorized to provide health care services.
(r) “Similarly licensed provider” means:
(1) for a physician:
(i) a physician who is board certified or eligible in the same practice
specialty; or
(ii) a group physician practice that contains board certified or
eligible physicians in the same practice specialty; [or]
(2) FOR A DENTIST:
(I) A DENTIST LICENSED TO PRACTICE DENTISTRY IN THE
STATE UNDER TITLE 4 OF THE HEALTH OCCUPATIONS ARTICLE WHO PERFORMS
THE SAME OR SIMILAR DENTAL SERVICES; OR
(II) A GROUP DENTAL PRACTICE THAT CONSISTS OF DENTISTS
LICENSED IN THE STATE UNDER TITLE 4 OF THE HEALTH OCCUPATIONS ARTICLE
WHO PERFORM THE SAME OR SIMILAR DENTAL SERVICES; OR
[(2)] (3) for a health care provider OR DENTIST who is not a physician
OR DENTIST, a health care provider OR DENTIST who holds the same type of license or
certification.
14–205.3.
(a) This section does not apply to on–call physicians or hospital–based physicians.
(b) An insurer may not:
(1) prohibit the assignment of benefits to a provider who is a physician OR
DENTIST by an insured; or
(2) refuse to directly reimburse a nonpreferred provider who is a physician
OR DENTIST under an assignment of benefits.
(c) If an insured has not provided an assignment of benefits, the insurer shall
include the following information with the payment to the insured for health care services
rendered by the nonpreferred provider who is a physician OR DENTIST:
(1) the specific claim covered by the payment;
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WES MOORE, Governor Ch. 737
(2) the amount paid for the claim;
(3) the amount that is the insured’s responsibility; and
(4) a statement instructing the insured to use the payment to pay the
nonpreferred provider in the event the insured has not paid the nonpreferred provider in
full for the health care services rendered by the nonpreferred provider.
(d) If a physician OR DENTIST who is a nonpreferred provider seeks an
assignment of benefits from an insured, the physician OR DENTIST shall provide the
following information to the insured, prior to performing a health care service:
(1) a statement informing the insured that the physician OR DENTIST is a
nonpreferred provider;
(2) a statement informing the insured that the physician OR DENTIST may
charge the insured for noncovered services;
(3) a statement informing the insured that the physician OR DENTIST may
charge the insured the balance bill for covered services;
(4) an estimate of the cost of services that the physician OR DENTIST will
provide to the insured;
(5) any terms of payment that may apply; and
(6) whether interest will apply and, if so, the amount of interest charged
by the physician OR DENTIST.
(e) A physician OR DENTIST who is a nonpreferred provider shall submit the
disclosure form developed by the Commissioner under subsection (f) of this section to
document to the insurer the assignment of benefits by an insured.
(f) The Commissioner shall develop disclosure forms to implement the
requirements under subsections (c) and (d) of this section.
(g) Notwithstanding the provisions of subsection (b) of this section, an insurer
may refuse to directly reimburse a nonpreferred provider under an assignment of benefits
if:
(1) the insurer receives notice of the assignment of benefits after the time
the insurer has paid the benefits to the insured;
(2) the insurer, due to an inadvertent administrative error, has previously
paid the insured;
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Ch. 737 2026 LAWS OF MARYLAND
(3) the insured withdraws the assignment of benefits before the insurer
has paid the benefits to the nonpreferred provider; or
(4) the insured paid the nonpreferred provider the full amount due at the
time of service.
14–410.1.
(A) IN THIS SECTION, “DENTIST” MEANS AN INDIVIDUAL LICENSED UNDER
TITLE 4 OF THE HEALTH OCCUPATIONS ARTICLE.
(B) EXCEPT AS PROVIDED IN SUBSECTION (G) OF THIS SECTION, A DENTAL
PLAN ORGANIZATION MAY NOT:
(1) PROHIBIT THE ASSIGNMENT OF BENEFITS TO A DENTIST BY AN
ENROLLEE; OR
(2) REFUSE TO DIRECTLY REIMBURSE A NONPREFERRED DENTIST
UNDER AN ASSIGNMENT OF BENEFITS.
(C) IF AN ENROLLEE HAS NOT PROVIDED AN ASSIGNMENT OF BENEFITS,
THE DENTAL PLAN ORGANIZATION SHALL INCLUDE THE FOLLOWING INFORMATION
WITH THE PAYMENT TO THE ENROLLEE FOR DENTAL SERVICES RENDERED BY THE
NONPREFERRED DENTIST:
(1) THE SPECIFIC CLAIM COVERED BY THE PAYMENT;
(2) THE AMOUNT PAID FOR THE CLAIM;
(3) THE AMOUNT THAT IS THE ENROLLEE’S RESPONSIBILITY OF THE
DENTAL PLAN ORGANIZATION; AND
(4) A STATEMENT INSTRUCTING THE ENROLLEE TO USE THE
PAYMENT TO PAY THE NONPREFERRED DENTIST IN THE EVENT THAT THE ENROLLEE
HAS NOT PAID THE NONPREFERRED DENTIST IN FULL FOR DENTAL SERVICES
RENDERED BY THE NONPREFERRED DENTIST.
(D) IF A NONPREFERRED DENTIST SEEKS AN ASSIGNMENT OF BENEFITS
FROM AN ENROLLEE, THE DENTIST SHALL PROVIDE THE FOLLOWING INFORMATION
TO THE ENROLLEE BEFORE PERFORMING A DENTAL SERVICE:
(1) A STATEMENT INFORMING THE ENROLLEE THAT THE DENTIST IS
A NONPREFERRED DENTIST;
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WES MOORE, Governor Ch. 737
(2) A STATEMENT INFORMING THE ENROLLEE THAT THE DENTIST
MAY CHARGE THE ENROLLEE FOR NONCOVERED SERVICES;
(3) A STATEMENT INFORMING THE ENROLLEE THAT THE DENTIST
MAY CHARGE THE ENROLLEE THE BALANCE BILL FOR COVERED SERVICES;
(4) AN ESTIMATE OF THE COST OF SERVICES THAT THE DENTIST WILL
PROVIDE TO THE ENROLLEE;
(5) ANY TERMS OF PAYMENT THAT MAY APPLY; AND
(6) WHETHER INTEREST WILL APPLY AND, IF SO, THE AMOUNT OF
INTEREST CHARGED BY THE DENTIST.
(E) A NONPREFERRED DENTIST SHALL SUBMIT THE DISCLOSURE FORM
DEVELOPED BY THE COMMISSIONER UNDER SUBSECTION (F) OF THIS SECTION TO
DOCUMENT TO THE DENTAL PLAN ORGANIZATION THE ASSIGNMENT OF BENEFITS
BY THE ENROLLEE.
(F) THE COMMISSIONER SHALL DEVELOP THE FORMS NECESSARY TO
IMPLEMENT THIS SUBSECTION SECTION.
(G) A DENTAL PLAN ORGANIZATION MAY REFUSE TO DIRECTLY REIMBURSE
A NONPREFERRED DENTIST UNDER AN ASSIGNMENT OF BENEFITS IF:
(1) THE DENTAL PLAN ORGANIZATION RECEIVES NOTICE OF THE
ASSIGNMENT OF BENEFITS AFTER THE TIME THE DENTAL PLAN ORGANIZATION HAS
PAID THE BENEFITS TO THE ENROLLEE;
(2) THE ENROLLEE WITHDRAWS THE ASSIGNMENT OF BENEFITS
BEFORE THE DENTAL PLAN ORGANIZATION HAS PAID THE BENEFITS TO THE
NONPREFERRED DENTIST; OR
(3) THE ENROLLEE PAID THE NONPREFERRED DENTIST THE FULL
AMOUNT DUE AT THE TIME OF SERVICE.
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect
January 1, 2027.
Approved by the Governor, May 26, 2026.
–5–Every fact on this page links to its source, starting with the official bill record.