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
 
 
 
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.
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