| 1 | 1 | | By: Carona, Ellis S.B. No. 554 |
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| 2 | 2 | | Van de Putte |
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| 3 | 3 | | (Lozano) |
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| 4 | 4 | | |
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| 5 | 5 | | |
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| 6 | 6 | | A BILL TO BE ENTITLED |
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| 7 | 7 | | AN ACT |
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| 8 | 8 | | relating to contracts between dentists and health maintenance |
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| 9 | 9 | | organizations or insurers. |
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| 10 | 10 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 11 | 11 | | SECTION 1. Subchapter I, Chapter 843, Insurance Code, is |
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| 12 | 12 | | amended by adding Section 843.3115 to read as follows: |
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| 13 | 13 | | Sec. 843.3115. CONTRACTS WITH DENTISTS. (a) In this |
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| 14 | 14 | | section, "covered service" means a dental care service for which |
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| 15 | 15 | | reimbursement is available under an enrollee's health care plan |
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| 16 | 16 | | contract, or for which reimbursement is available subject to a |
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| 17 | 17 | | contractual limitation, including: |
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| 18 | 18 | | (1) a deductible; |
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| 19 | 19 | | (2) a copayment; |
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| 20 | 20 | | (3) coinsurance; |
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| 21 | 21 | | (4) a waiting period; |
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| 22 | 22 | | (5) an annual or lifetime maximum limit; |
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| 23 | 23 | | (6) a frequency limitation; or |
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| 24 | 24 | | (7) an alternative benefit payment. |
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| 25 | 25 | | (b) A contract between a health maintenance organization |
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| 26 | 26 | | and a dentist may not limit the fee the dentist may charge for a |
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| 27 | 27 | | service that is not a covered service. |
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| 28 | 28 | | SECTION 2. Subchapter E, Chapter 1451, Insurance Code, is |
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| 29 | 29 | | amended by adding Section 1451.2065 to read as follows: |
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| 30 | 30 | | Sec. 1451.2065. CONTRACTS WITH DENTISTS. (a) In this |
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| 31 | 31 | | section, "covered service" means a dental care service for which |
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| 32 | 32 | | reimbursement is available under a patient's employee benefit plan |
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| 33 | 33 | | or health insurance policy, or for which reimbursement is available |
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| 34 | 34 | | subject to a contractual limitation, including: |
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| 35 | 35 | | (1) a deductible; |
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| 36 | 36 | | (2) a copayment; |
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| 37 | 37 | | (3) coinsurance; |
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| 38 | 38 | | (4) a waiting period; |
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| 39 | 39 | | (5) an annual or lifetime maximum limit; |
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| 40 | 40 | | (6) a frequency limitation; or |
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| 41 | 41 | | (7) an alternative benefit payment. |
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| 42 | 42 | | (b) A contract between an insurer and a dentist may not |
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| 43 | 43 | | limit the fee the dentist may charge for a service that is not a |
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| 44 | 44 | | covered service. |
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| 45 | 45 | | SECTION 3. Sections 843.3115 and 1451.2065, Insurance Code, |
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| 46 | 46 | | as added by this Act, apply only to a contract entered into or |
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| 47 | 47 | | renewed on or after the effective date of this Act. A contract |
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| 48 | 48 | | entered into or renewed before the effective date of this Act is |
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| 49 | 49 | | governed by the law in effect immediately before the effective date |
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| 50 | 50 | | of this Act, and that law is continued in effect for that purpose. |
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| 51 | 51 | | SECTION 4. This Act takes effect September 1, 2011. |
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