Bill Text: TX SB554 | 2011-2012 | 82nd Legislature | Comm Sub
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Relating to contracts between dentists and health maintenance organizations or insurers.
Spectrum: Bipartisan Bill
Status: (Passed) 2011-06-17 - Effective on 9/1/11 [SB554 Detail]
Download: Texas-2011-SB554-Comm_Sub.html
Bill Title: Relating to contracts between dentists and health maintenance organizations or insurers.
Spectrum: Bipartisan Bill
Status: (Passed) 2011-06-17 - Effective on 9/1/11 [SB554 Detail]
Download: Texas-2011-SB554-Comm_Sub.html
By: Carona, Ellis | S.B. No. 554 | ||
Van de Putte | |||
(Lozano) |
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relating to contracts between dentists and health maintenance | ||
organizations or insurers. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Subchapter I, Chapter 843, Insurance Code, is | ||
amended by adding Section 843.3115 to read as follows: | ||
Sec. 843.3115. CONTRACTS WITH DENTISTS. (a) In this | ||
section, "covered service" means a dental care 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 may not limit the fee the dentist may charge for a | ||
service that is not a covered service. | ||
SECTION 2. Subchapter E, Chapter 1451, Insurance Code, is | ||
amended by adding Section 1451.2065 to read as follows: | ||
Sec. 1451.2065. CONTRACTS WITH DENTISTS. (a) In this | ||
section, "covered service" means a dental care 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 may not | ||
limit the fee the dentist may charge for a service that is not a | ||
covered service. | ||
SECTION 3. Sections 843.3115 and 1451.2065, Insurance Code, | ||
as added by this Act, apply only to a contract entered into or | ||
renewed on or after the effective date of this Act. A contract | ||
entered into or renewed before the effective date of this Act 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 4. This Act takes effect September 1, 2011. |