Texas 2019 - 86th Regular

Texas House Bill HB1862 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	86R9985 JES-F
2	2	By: Reynolds H.B. No. 1862
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to certain required disclosures and prohibited practices
8	8	of certain employee benefit plans and health insurance policies
9	9	that provide benefits for dental care services.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Section 1451.205, Insurance Code, is amended to
12	12	read as follows:
13	13	Sec. 1451.205. DISCLOSURE OF BENEFIT TERMS. (a) An
14	14	employee benefit plan or health insurance policy shall:
15	15	(1) if applicable, disclose that the benefit for
16	16	dental care services offered is limited to the least costly
17	17	treatment; and
18	18	(2) specify in dollars and cents the amount of the
19	19	payment or reimbursement to be provided for dental care services or
20	20	define and explain the standard on which payment of benefits or
21	21	reimbursement for the cost of dental care services is based, such
22	22	as:
23	23	(A) "usual and customary" fees;
24	24	(B) "reasonable and customary" fees;
25	25	(C) "usual, customary, and reasonable" fees; or
26	26	(D) words of similar meaning.
27	27	(b) A person or entity who provides or issues an employee
28	28	benefit plan or health insurance policy or the employer or employee
29	29	organization, if applicable, shall establish an Internet website to
30	30	provide resources and information to dentists, insureds,
31	31	participants, employees, and members.
32	32	(c) An employee benefit plan or health insurance policy
33	33	shall make accessible on the Internet website established under
34	34	Subsection (b) information about the plan or policy sufficient for
35	35	patients and dentists to determine the type of dental care services
36	36	covered by the plan or policy and the amount of the payment or
37	37	reimbursement available for those services under the plan or
38	38	policy. Access to the Internet website must be at no charge to
39	39	patients under the plan or policy and dentists providing dental
40	40	care services to the patients.
41	41	SECTION 2. Section 1451.206(a), Insurance Code, is amended
42	42	to read as follows:
43	43	(a) The employee benefit plan or health insurance policy
44	44	shall:
45	45	(1) provide:
46	46	(A) [(1)] that payment or reimbursement for a
47	47	noncontracting provider dentist shall be the same as payment or
48	48	reimbursement for a contracting provider dentist; [and]
49	49	(B) [(2)] that the party to or beneficiary of the
50	50	plan or policy may assign the right to payment or reimbursement to
51	51	the dentist who provides the dental care services; and
52	52	(C) one or more methods of payment or
53	53	reimbursement that provide the dentist 100 percent of the
54	54	contracted amount of the payment or reimbursement and that do not
55	55	require the dentist to incur a fee to access the payment or
56	56	reimbursement; and
57	57	(2) disclose on the Internet website required under
58	58	Section 1451.205 and on request of a dentist or a party to or
59	59	beneficiary of the plan or policy the fees, if any, associated with
60	60	the methods of payment or reimbursement available under the plan or
61	61	policy.
62	62	SECTION 3. Sections 1451.207(a) and (c), Insurance Code,
63	63	are amended to read as follows:
64	64	(a) An employee benefit plan or health insurance policy may
65	65	not:
66	66	(1) interfere with or prevent an individual who is a
67	67	party to or beneficiary of the plan or policy from selecting a
68	68	dentist of the individual's choice to provide a dental care service
69	69	the plan or policy offers if the dentist selected is licensed in
70	70	this state to provide the service;
71	71	(2) deny a dentist the right to participate as a
72	72	contracting provider under the plan or policy if the dentist is
73	73	licensed to provide the dental care services the plan or policy
74	74	offers;
75	75	(3) authorize a person to regulate, interfere with, or
76	76	intervene in the provision of dental care services a dentist
77	77	provides a patient, including diagnosis, if the dentist practices
78	78	within the scope of the dentist's license; [or]
79	79	(4) require a dentist to make or obtain a dental x-ray
80	80	or other diagnostic aid in providing dental care services; or
81	81	(5) deduct the amount of an overpayment of a claim from
82	82	a payment or reimbursement of another claim unless both claims were
83	83	for dental services provided to the same patient by the same
84	84	dentist.
85	85	(c) This section does not prohibit the predetermination of
86	86	benefits for dental care expenses before the attending dentist
87	87	provides treatment. An employee benefit plan or health insurance
88	88	policy that provides a written predetermination of benefits to a
89	89	dentist with respect to a dental care service for a patient that
90	90	includes a specific benefit payment or reimbursement amount may not
91	91	pay or reimburse the dentist for providing that service to the
92	92	patient in an amount that is less than the amount set forth in the
93	93	predetermination.
94	94	SECTION 4. The changes in law made by this Act apply only to
95	95	an employee benefit plan or health insurance policy that provides
96	96	benefits for dental care services that is delivered, issued for
97	97	delivery, renewed, or contracted for on or after the effective date
98	98	of this Act. An employee benefit plan or health insurance policy
99	99	that provides benefits for dental care services that is delivered,
100	100	issued for delivery, renewed, or contracted for before the
101	101	effective date of this Act is governed by the law as it existed
102	102	immediately before the effective date of this Act, and that law is
103	103	continued in effect for that purpose.
104	104	SECTION 5. This Act takes effect September 1, 2019.