86R9985 JES-F
By: Reynolds H.B. No. 1862
A BILL TO BE ENTITLED
AN ACT
relating to certain required disclosures and prohibited practices
of certain employee benefit plans and health insurance policies
that provide benefits for dental care services.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1451.205, Insurance Code, is amended to
read as follows:
Sec. 1451.205. DISCLOSURE OF BENEFIT TERMS. (a) An
employee benefit plan or health insurance policy shall:
(1) if applicable, disclose that the benefit for
dental care services offered is limited to the least costly
treatment; and
(2) specify in dollars and cents the amount of the
payment or reimbursement to be provided for dental care services or
define and explain the standard on which payment of benefits or
reimbursement for the cost of dental care services is based, such
as:
(A) "usual and customary" fees;
(B) "reasonable and customary" fees;
(C) "usual, customary, and reasonable" fees; or
(D) words of similar meaning.
(b) A person or entity who provides or issues an employee
benefit plan or health insurance policy or the employer or employee
organization, if applicable, shall establish an Internet website to
provide resources and information to dentists, insureds,
participants, employees, and members.
(c) An employee benefit plan or health insurance policy
shall make accessible on the Internet website established under
Subsection (b) information about the plan or policy sufficient for
patients and dentists to determine the type of dental care services
covered by the plan or policy and the amount of the payment or
reimbursement available for those services under the plan or
policy. Access to the Internet website must be at no charge to
patients under the plan or policy and dentists providing dental
care services to the patients.
SECTION 2. Section 1451.206(a), Insurance Code, is amended
to read as follows:
(a) The employee benefit plan or health insurance policy
shall:
(1) provide:
(A) [(1)] that payment or reimbursement for a
noncontracting provider dentist shall be the same as payment or
reimbursement for a contracting provider dentist; [and]
(B) [(2)] that the party to or beneficiary of the
plan or policy may assign the right to payment or reimbursement to
the dentist who provides the dental care services; and
(C) one or more methods of payment or
reimbursement that provide the dentist 100 percent of the
contracted amount of the payment or reimbursement and that do not
require the dentist to incur a fee to access the payment or
reimbursement; and
(2) disclose on the Internet website required under
Section 1451.205 and on request of a dentist or a party to or
beneficiary of the plan or policy the fees, if any, associated with
the methods of payment or reimbursement available under the plan or
policy.
SECTION 3. Sections 1451.207(a) and (c), Insurance Code,
are amended to read as follows:
(a) An employee benefit plan or health insurance policy may
not:
(1) interfere with or prevent an individual who is a
party to or beneficiary of the plan or policy from selecting a
dentist of the individual's choice to provide a dental care service
the plan or policy offers if the dentist selected is licensed in
this state to provide the service;
(2) deny a dentist the right to participate as a
contracting provider under the plan or policy if the dentist is
licensed to provide the dental care services the plan or policy
offers;
(3) authorize a person to regulate, interfere with, or
intervene in the provision of dental care services a dentist
provides a patient, including diagnosis, if the dentist practices
within the scope of the dentist's license; [or]
(4) require a dentist to make or obtain a dental x-ray
or other diagnostic aid in providing dental care services; or
(5) deduct the amount of an overpayment of a claim from
a payment or reimbursement of another claim unless both claims were
for dental services provided to the same patient by the same
dentist.
(c) This section does not prohibit the predetermination of
benefits for dental care expenses before the attending dentist
provides treatment. An employee benefit plan or health insurance
policy that provides a written predetermination of benefits to a
dentist with respect to a dental care service for a patient that
includes a specific benefit payment or reimbursement amount may not
pay or reimburse the dentist for providing that service to the
patient in an amount that is less than the amount set forth in the
predetermination.
SECTION 4. The changes in law made by this Act apply only to
an employee benefit plan or health insurance policy that provides
benefits for dental care services that is delivered, issued for
delivery, renewed, or contracted for on or after the effective date
of this Act. An employee benefit plan or health insurance policy
that provides benefits for dental care services that is delivered,
issued for delivery, renewed, or contracted for before the
effective date of this Act is governed by the law as it existed
immediately before the effective date of this Act, and that law is
continued in effect for that purpose.
SECTION 5. This Act takes effect September 1, 2019.