Utah dental practices are diverse, but their legal needs are surprisingly similar. As a Utah dental attorney, clients often ask me about dental membership programs. A lot of dental practices are interested in them. After all, they are a smart way to potentially tap into the uninsured market. However, if the membership program looks too much like insurance, a Utah dentist may invoke the oversight of the Utah Insurance Commission, which would be problematic. Utah Insurance Commission usually equals lots of regulations and cost.
So, if you're interested in creating a Utah dental membership program for your Utah dental practice, here are some things to consider:
Make sure your Utah dental membership plan is a Medical Retainer Agreement, not a Health Discount Program. According to Utah law, a valid Medical Retainer Agreement (which is the legal document you will create to implement your Utah dental membership plan) must include:
1. a description of "specific routine health care services that are included in the contract;"
2. a written statement that the retainer agreement is not health insurance; and
3. text that clearly prohibits the health care provider from billing an insurer for the services delivered under the agreement (i.e. the membership program).
In summary, Utah dental membership programs can be great for Utah dental practices. However, they can easily resemble insurance plans, if the dental practice implements them incorrectly. And if you dental membership program looks like an insurance plan, the Utah Insurance Commission will probably treat it like one.
-Jeremiah Riley, Esq
Jeremiah Riley is a Utah dental attorney licensed to practice law in Utah and Alaska. He helps dental clients buy and sell Utah dental practices. He also helps Utah dentists navigate other legal matters common to health care providers.