CurrentKentucky Department of InsurancePolicy N/A

Dental benefit assignment (out-of-network)

Customize your policy alerts

Sign up for all Kentucky Department of Insurance policy alerts

Know when Kentucky Department of Insurance releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Guidance and a Department-created assignment form implementing KRS 304.17C-137 (2025 HB 210) that lets covered persons assign out-of-network dental benefit payments directly to providers; applies to insurers, providers, and covered persons operating in Kentucky.

Policy Summary

PayerKentucky Department of Insurance

PolicyDental benefit assignment (out-of-network)

Policy CodePolicy N/A

Change TypeGuidance / Implementation bulletin

Effective DateDec 15, 2025

Next Review DateN/A

Key ActionProviders may receive direct payment when a covered person assigns out-of-network dental benefits using the Department form.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2026-01-01dental assignment effective

2025-12-15bulletin effective

30 daysprovider notice/refund window

KRS 304.17C-137statutory authority

Dental Benefit Assignment: Criteria and Obligations

Dental benefit assignment criteria and obligations

Requirements and practical effects under KRS 304.17C-137 per the Department bulletin and the Department-created dental benefit assignment form:

Carriers must accept the Department-created dental benefit assignment form and, when instructed by the covered person, pay out-of-network dental providers directly.

Use of the assignment form does not create a contractual relationship between the dental carrier and the provider.

The assignment is optional for the covered person; providers must inform covered persons that the provider is non-participating (out-of-network), that assignment is optional, and that non-participating providers may charge for non-covered services or any portion of a covered service not reimbursed by the carrier (i.e., may balance-bill).

Both the covered person and the provider must sign the assignment form; a photocopy of the benefit assignment is as valid as the original; the assignment remains in effect until the covered person revokes it in writing and provides a copy to the dental carrier.

After receiving a revocation of an assignment from a patient, the dental carrier shall promptly send a copy to the dental provider marked with the effective date.

If a credit/overpayment occurs, the provider shall give the covered person notice within 30 days and, if the covered person requests a refund, shall refund the credit within 30 days of the request.

If the provider first receives payment from the patient and later receives payment from the dental carrier under the assignment, the provider shall refund the patient within 30 days of receiving the carrier payment unless the patient and provider agree otherwise in writing.

The form authorizes release of medical and treatment information to the dental carrier and authorizes the provider to act as the covered person's agent in obtaining payment from the dental carrier.

The assignment does not guarantee payment or full payment; carriers pay only benefits allowable under their out-of-network policy terms and carriers retain authority to define plan scope and negotiate contracts consistent with the statute.

Insurers, licensees, and registered entities must notify their agents and employees of the provisions of the dental benefit assignment law and the use of the new form.

Provider Payment, Notice, and Refund Obligations

Prior Authorization

Accept direct payment only with completed Department assignment form; no contract created

Providers may accept direct payment when a covered person signs and submits the Department’s dental benefit assignment form authorizing assignment of out‑of‑network dental benefits to the provider. The assignment does not create a contract between the dental carrier and the provider — carriers and providers remain separate parties.

Covered person must sign the Department form to assign payment to the provider.
Use of the form does not establish a contractual relationship between the dental carrier and the provider.

Key Definitions

inv-03: Assignment of Benefits

DefinitionAssignment of Benefits: authorization by a covered person for their dental carrier to pay insurance benefits directly to an out-of-network provider or dentist.

PurposeAllows the dental carrier to pay the service provider directly so the covered person does not have to seek reimbursement after paying in advance.

OptionalityAssignment is optional; covered persons are not required to assign their out-of-network dental benefits to providers.

Effect on ContractingUse of the assignment does not create or imply that the provider is part of the carrier's network; it simply directs payment to the provider.

inv-04: Out-of-Network

DefinitionOut-of-Network: a dental service provider who is not part of the dental carrier's network (also called non-network or non-participating).

Form UseThe Department-created dental benefit assignment form is intended specifically for use with out-of-network dental service providers.

Payment ImplicationUsing the form may permit the carrier to pay the out-of-network provider directly, but does not guarantee payment or payment in full under the carrier's out-of-network policy terms.

Balance-Billing RiskProviders may still balance-bill the covered person for amounts not paid by the carrier; assignment does not eliminate potential patient liability.

Policy Summary

PayerKentucky Department of Insurance

PolicyDental benefit assignment (out-of-network)

Policy CodePolicy N/A

Change TypeGuidance / Implementation bulletin

Effective DateDec 15, 2025

Next Review DateN/A

Key ActionProviders may receive direct payment when a covered person assigns out-of-network dental benefits using the Department form.

SourceLink

On This Page

OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

Dental benefit assignment (out-of-network)

Customize your policy alerts

Sign up for all Kentucky Department of Insurance policy alerts

Know when Kentucky Department of Insurance releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Dental Benefit Assignment: Criteria and Obligations

Dental benefit assignment criteria and obligations

Requirements and practical effects under KRS 304.17C-137 per the Department bulletin and the Department-created dental benefit assignment form:

Carriers must accept the Department-created dental benefit assignment form and, when instructed by the covered person, pay out-of-network dental providers directly.

Use of the assignment form does not create a contractual relationship between the dental carrier and the provider.

After receiving a revocation of an assignment from a patient, the dental carrier shall promptly send a copy to the dental provider marked with the effective date.

If a credit/overpayment occurs, the provider shall give the covered person notice within 30 days and, if the covered person requests a refund, shall refund the credit within 30 days of the request.

The form authorizes release of medical and treatment information to the dental carrier and authorizes the provider to act as the covered person's agent in obtaining payment from the dental carrier.

Insurers, licensees, and registered entities must notify their agents and employees of the provisions of the dental benefit assignment law and the use of the new form.

Provider Payment, Notice, and Refund Obligations

Prior Authorization

Accept direct payment only with completed Department assignment form; no contract created

Covered person must sign the Department form to assign payment to the provider.
Use of the form does not establish a contractual relationship between the dental carrier and the provider.

Key Definitions

inv-03: Assignment of Benefits

DefinitionAssignment of Benefits: authorization by a covered person for their dental carrier to pay insurance benefits directly to an out-of-network provider or dentist.

PurposeAllows the dental carrier to pay the service provider directly so the covered person does not have to seek reimbursement after paying in advance.

OptionalityAssignment is optional; covered persons are not required to assign their out-of-network dental benefits to providers.

Effect on ContractingUse of the assignment does not create or imply that the provider is part of the carrier's network; it simply directs payment to the provider.

inv-04: Out-of-Network

DefinitionOut-of-Network: a dental service provider who is not part of the dental carrier's network (also called non-network or non-participating).

Form UseThe Department-created dental benefit assignment form is intended specifically for use with out-of-network dental service providers.

Balance-Billing RiskProviders may still balance-bill the covered person for amounts not paid by the carrier; assignment does not eliminate potential patient liability.