{"data":{"id":"us-ut/utah-code-31a-22-646.1","jurisdiction":"us-ut","citation":"Utah Code § 31A-22-646.1","heading":"Leasing requirements for dental plans.","body":"(1) As used in this section:\n(a) \"Contracting entity\" means a person that enters into a direct contract with a provider for the delivery of dental services in the ordinary course of business, including a third party administrator or a dental carrier.\n(b) \"Dental carrier\" means a dental insurance company, dental service corporation, or dental plan organization authorized to provide a dental plan.\n(c) \"Dental plan\" means the same as that term is defined in Section 31A-22-646.\n(d)\n(i) \"Dental services\" means services for the diagnosis, prevention, treatment, or cure of a dental condition, illness, injury, or disease.\n(ii) \"Dental services\" does not include services that a provider delivers and bills as medical expenses under a health benefit plan.\n(e)\n(i) \"Dental service contractor\" means an individual who:\n(A) accepts prepayment for dental services; or\n(B) for the benefit of another individual, accepts payment for providing to the individual the opportunity to receive dental services in the future.\n(ii) \"Dental service contractor\" does not include a provider or professional dental corporation that accepts prepayment on a fee-for-service basis for providing specific dental services to individual patients for whom the services have been pre-diagnosed.\n(f)\n(i) \"Provider\" means a person who, acting within the scope of licensure or certification, provides dental services or supplies defined by the dental plan.\n(ii) \"Provider\" does not include a physician organization or physician hospital organization that leases or rents the physician organization's or physician hospital organization's network to a third party.\n(g) \"Provider network contract\" means a contract between a contracting entity and a provider that:\n(i) specifies the rights and responsibilities of the contracting entity; and\n(ii) provides for the delivery and payment of dental services to an enrollee.\n(h)\n(i) \"Third party\" means a person that enters into a contract with a contracting entity or with another third party to gain access to the dental services or contractual discounts of a provider network contract.\n(ii) \"Third party\" does not include an employer or other group for whom the dental carrier or contracting entity provides administrative services.\n(2) A contracting entity may grant a third party access to a provider network contract regarding dental services, including a provider's dental services, or a contractual discount provided under a provider network contract for dental services if:\n(a) if the contracting entity is an insurer, the insurer complies with Subsection (3);\n(b) the contract between the contracting entity and a person subject to the third-party access complies with Subsection (4); and\n(c) the contracting entity complies with Subsection (5).\n(3) An insurer shall:\n(a) at the time a contract is entered into or renewed, or when there is a material modification to a contract that is relevant to third-party access to a provider network contract, allow a provider which is part of the insurer's provider network to:\n(i) choose to not participate in third-party access; or\n(ii) enter into a contract directly with the third party that acquired the provider network;\n(b) allow a provider to opt out of lease arrangements without canceling or ending a contractual relationship with the insurer; and\n(c) when initially contracting with a provider, accept a qualified provider even if a provider rejects a network lease provision.\n(4) A contracting entity described in Subsection (2) shall ensure that the contract described in Subsection (2)(b) includes the following:\n(a) a provision indicating the contracting entity may enter into an agreement with a third party to allow the third party to obtain the contracting entity's rights and responsibilities as if the third party were the contracting entity;\n(b) if the contracting entity is a dental carrier, a provision indicating that the provider chose to participate in third-party access at the time the provider network contract was entered into or renewed; and\n(c) if the contracting entity is an insurer, a provision indicating:\n(i) that the contract grants a third party access to the provider network; and\n(ii) for a contract with a dental carrier, the dentist has the right to choose not to participate in third-party access.\n(5) A contracting entity shall:\n(a) provide a provider, in writing or electronic form, each third party in existence as of the date the contract is entered into;\n(b) maintain a list of each third party in existence on the contracting entity's website that is updated at least once every 90 days;\n(c) require a third party to identify the source of the discount on all remittance advices or explanations of payment under which a discount is taken unless the transaction is an electronic transaction mandated by the Health Insurance Portability and Accountability Act;\n(d) notify a third party of the termination of a provider network contract no later than 30 days after the day on which the contract terminates with the contracting entity;\n(e) at least 30 days before the day on which a third party begins leasing a network provider, notify each network provider subject to the lease;\n(f) make available to a participating provider, within 30 days after the day on which the provider makes a request, a copy of the provider network contract at issue in the adjudication of a claim; and\n(g) maintain a list of the contracting entity's affiliates on the contracting entity's website.\n(6) A third party that gains access to a contract under this section:\n(a) shall comply with each term of the contract to which the third party gains access; and\n(b) loses all rights to a provider's discounted rate as of the termination date of the provider network contract.\n(7) A contracting entity or third party may not require a provider to perform services under a provider network contract if a third party gains access to a contract in violation of this section.\n(8) This section does not apply to:\n(a) a contracting entity granting access to a provider network contract to:\n(i) an entity that operates in accordance with the brand licensee program of the contracting entity; or\n(ii) an entity that is an affiliate of the contracting entity; and\n(b) a provider network contract for dental services provided to beneficiaries of a state sponsored health program, including Medicaid and the Children's Health Insurance Program.\n(9) A contract executed or renewed on or after January 1, 2022:\n(a) may not waive the provisions of this section; and\n(b) is null and void if the contract contains provisions that conflict with the provisions of this section or that purports to waive a requirement of this section.","path":["Title 31A Insurance Code","Chapter 31A-22 Contracts in Specific Lines","Part 31A-22-6 Accident and Health Insurance"],"source_url":"https://le.utah.gov/xcode/Title31A/Chapter22/31A-22-S646.1.html","current_through":"2026 General Session","vintage":"","retrieved_at":"2026-09-03T11:34:33Z","sha256":"09946a2312c3b46345cabd62dceda5f6fcdef2d95a35b7a90c0ccb4cd90ebead","source_id":"us-ut","stale":false,"prev":"us-ut/utah-code-31a-22-646","next":"us-ut/utah-code-31a-22-646.2"},"notice":"GroundRules: Original legal text. Not legal advice."}