Bill Text: TX HB1862 | 2019-2020 | 86th Legislature | Introduced
Bill Title: Relating to certain required disclosures and prohibited practices of certain employee benefit plans and health insurance policies that provide benefits for dental care services.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2019-03-05 - Referred to Insurance [HB1862 Detail]
Download: Texas-2019-HB1862-Introduced.html
86R9985 JES-F | ||
By: Reynolds | H.B. No. 1862 |
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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) [ |
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noncontracting provider dentist shall be the same as payment or | ||
reimbursement for a contracting provider dentist; [ |
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(B) [ |
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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; [ |
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(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. |