83R7029 SCL-D
By: Carona S.B. No. 632
A BILL TO BE ENTITLED
AN ACT
relating to contracts between dentists, optometrists, or
therapeutic optometrists and health maintenance organizations or
insurers.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 843.3115, Insurance Code, is amended to
read as follows:
Sec. 843.3115. CONTRACTS WITH DENTISTS, OPTOMETRISTS, OR
THERAPEUTIC OPTOMETRISTS. (a) In this section, "covered product
or service" means a dental care service or vision care product or
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, optometrist, or therapeutic optometrist may not
limit the fee the dentist, optometrist, or therapeutic optometrist
may charge for a product or service that is not a covered product or
service.
(c) A contract between a health maintenance organization
and a dentist, optometrist, or therapeutic optometrist may not
require a discount on a product or service that is not a covered
product or service.
SECTION 2. The heading to Subchapter E, Chapter 1451,
Insurance Code, is amended to read as follows:
SUBCHAPTER E. DENTAL AND VISION CARE BENEFITS IN HEALTH INSURANCE
POLICIES OR EMPLOYEE BENEFIT PLANS
SECTION 3. Section 1451.201, Insurance Code, is amended by
adding Subdivision (4) to read as follows:
(4) "Vision care product or service" means a product
or service provided within the scope of the practice of optometry or
therapeutic optometry under Chapter 351, Occupations Code.
SECTION 4. Section 1451.2065, Insurance Code, is amended to
read as follows:
Sec. 1451.2065. CONTRACTS WITH DENTISTS, OPTOMETRISTS, OR
THERAPEUTIC OPTOMETRISTS. (a) In this section, "covered product
or service" means a dental care service or vision care product or
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,
optometrist, or therapeutic optometrist may not limit the fee the
dentist, optometrist, or therapeutic optometrist may charge for a
product or service that is not a covered product or service.
(c) A contract between an insurer and a dentist,
optometrist, or therapeutic optometrist may not require a discount
on a product or service that is not a covered product or service.
SECTION 5. The change in law made by this Act applies only
to a contract entered into or renewed on or after January 1, 2014. A
contract entered into or renewed before January 1, 2014, 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 6. This Act takes effect September 1, 2013.