By: Carona, Ellis S.B. No. 554
Van de Putte
(Lozano)
A BILL TO BE ENTITLED
AN ACT
relating to contracts between dentists and health maintenance
organizations or insurers.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter I, Chapter 843, Insurance Code, is
amended by adding Section 843.3115 to read as follows:
Sec. 843.3115. CONTRACTS WITH DENTISTS. (a) In this
section, "covered service" means a dental care service for which
reimbursement is available under an enrollee's health care plan
contract, or for which reimbursement is available subject to a
contractual limitation, including:
(1) a deductible;
(2) a copayment;
(3) coinsurance;
(4) a waiting period;
(5) an annual or lifetime maximum limit;
(6) a frequency limitation; or
(7) an alternative benefit payment.
(b) A contract between a health maintenance organization
and a dentist may not limit the fee the dentist may charge for a
service that is not a covered service.
SECTION 2. Subchapter E, Chapter 1451, Insurance Code, is
amended by adding Section 1451.2065 to read as follows:
Sec. 1451.2065. CONTRACTS WITH DENTISTS. (a) In this
section, "covered service" means a dental care service for which
reimbursement is available under a patient's employee benefit plan
or health insurance policy, or for which reimbursement is available
subject to a contractual limitation, including:
(1) a deductible;
(2) a copayment;
(3) coinsurance;
(4) a waiting period;
(5) an annual or lifetime maximum limit;
(6) a frequency limitation; or
(7) an alternative benefit payment.
(b) A contract between an insurer and a dentist may not
limit the fee the dentist may charge for a service that is not a
covered service.
SECTION 3. Sections 843.3115 and 1451.2065, Insurance Code,
as added by this Act, apply only to a contract entered into or
renewed on or after the effective date of this Act. A contract
entered into or renewed before the effective date of this Act is
governed by the law in effect immediately before the effective date
of this Act, and that law is continued in effect for that purpose.
SECTION 4. This Act takes effect September 1, 2011.