HB 2722

                                                  PRINTER'S NO.   3804
                 THE GENERAL ASSEMBLY OF PENNSYLVANIA
                     HOUSE BILL
                     No. 2722
                                            Session of
                                              2026
INTRODUCED BY HOWARD, RUSNOCK, SANCHEZ, HILL-EVANS, KINKEAD,
   KHAN AND PASHINSKI, JULY 30, 2026
REFERRED TO COMMITTEE ON INSURANCE, JULY 31, 2026
                                 AN ACT
1 Amending Title 40 (Insurance) of the Pennsylvania Consolidated
2    Statutes, in electronic notice of insurance practices,
3    providing for dental insurance transparency.
4    The General Assembly of the Commonwealth of Pennsylvania
5 hereby enacts as follows:
6    Section 1.     Title 40 of the Pennsylvania Consolidated
7 Statutes is amended by adding a section to read:
8 § 5014.    Dental insurance transparency.
9    (a)    Portal.--Every dental insurer in this Commonwealth shall
10 maintain a secure electronic provider portal that is accessible
11 to all licensed dental providers and authorized staff. The
12 provider portal shall provide access to complete and accurate
13 benefit information for covered patients, updated daily. All
14 information on the portal shall be reflective of statements
15 given by company representatives and prior dental provider-
16 dental insurer agreements and provide complete treatment and
17 claims history for at least the last three years, including:
18(1)   Procedures billed.
1(2)   Dates of service.
2(3)   Benefits payments.
3(4)   Denials.
4(5)   Frequency of utilization.
5(6)   Remaining limitations and eligibility data.
6    (b)   Use.--Information required under this section shall be
7 available without additional contact with the dental insurer or
8 a representative beyond the provider platform. Dental insurers
9 shall update the portal no less frequently than once every 24-
10 hour period. Any statement of a benefit qualified for or
11 provided by a dental insurer, either verbally, electronically or
12 in writing by a representative of the dental insurer or the
13 dental insurer, shall be binding upon the insurer for purposes
14 of claim adjudication and patient benefit determination, and any
15 statement conveyed to the patient or provider regarding a dollar
16 amount shall be construed to be the binding amount, with
17 exceptions made for:
18(1)   fraud;
19(2)   material misrepresentation by the provider or
20    patient; or
21(3)   eligibility termination occurring after the
22    information was provided.
23    (c)   Record retention and access.--Dental insurers shall
24 maintain recordings or transcripts of benefit breakdown
25 verification communications for a minimum of three years. Upon
26 request, copies of the verification transcripts shall be made
27 available to dental providers and authorized staff. Dental
28 insurers shall permit secure electronic access to provider
29 portal information through standardized application programming
30 interfaces and may implement reasonable cybersecurity and
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1 authentication safeguards. An insurer under this section may not
2 unreasonably restrict automated electronic access and shall
3 comply with interoperability standards established by the
4 department.
5    (d)   Enforcement and penalties.--The department shall enforce
6 this section and may promulgate rules and regulations as
7 necessary to enable compliance with this section. A dental
8 insurer that violates this section shall be subject to any of
9 the following, in accordance with sections 3510 (relating to
10 failure to give notice) and 3803 (relating to retroactive denial
11 of reimbursement):
12(1)   Reimbursement of dental provider on office-specific
13    service fees.
14(2)   Corrective action plans.
15(3)   Administrative fines not exceeding $10,000.
16    (e)   Failure to comply.--Dental insurers that fail to comply
17 with this section shall pay the dental provider's specific
18 office fees rather than the allotted amount agreed to in the
19 agreed fee schedule within a 30-business-day period. If the
20 dental insurer fails to reimburse dental providers within the
21 allotted time, the provider may file suit in any court of
22 competent jurisdiction to recover the specific office fees, in
23 addition to reasonable attorney fees and court costs. Upon
24 filing a case, all insurance-mandated deadlines pertaining to
25 provider filings pertinent to that procedure shall be paused
26 pending the resolution of the dispute.
27    (f)   Definitions.--As used in this section, the following
28 words and phrases shall have the meanings given to them in this
29 subsection unless the context clearly indicates otherwise:
30    "Benefit information."    The term includes:
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1(1)    Eligibility status.
2(2)    Plan effective dates.
3(3)    Annual maximums.
4(4)    Deductibles.
5(5)    Frequency and limitations.
6(6)    Waiting periods.
7(7)    Missing tooth clauses.
8(8)    Downgrades.
9(9)    Exclusions.
10(10)     Prior authorization requirements.
11(11)     Coordination of benefits.
12(12)     Remaining benefits.
13(13)     Claim status.
14(14)     Payment history.
15    "Dental insurer."    Any entity offering, administering or
16 underwriting dental insurance benefits in this Commonwealth.
17    "Fee schedule."     A payment amount previously agreed upon
18 between dental providers and dental insurers that outlines the
19 amount the insurer will pay for each procedure billed by the
20 provider.
21    "Provider portal."    Any Internet website, electronic platform
22 or digital system used by a dental insurer to provide
23 information to participating or nonparticipating dental
24 providers.
25    "Specific office fee."       The original price for a procedure
26 done by a provider, set by a provider, which is originally sent
27 to the dental insurer for billing purposes. The term does not
28 include the fee schedule agreed upon between the dental insurer
29 and dental provider.
30    Section 2.    This act shall take effect in one year.
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