Bill Text: TX SB554 | 2011-2012 | 82nd Legislature | Enrolled
Bill Title: Relating to contracts between dentists and health maintenance organizations or insurers.
Sponsorship: Bipartisan Bill
Status: (Passed) 2011-06-17 - Effective on 9/1/11 [SB554 Detail]
Download: Texas-2011-SB554-Enrolled.html
| S.B. No. 554 | ||
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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. | ||
| ______________________________ | ______________________________ | |
| President of the Senate | Speaker of the House | |
| I hereby certify that S.B. No. 554 passed the Senate on | ||
| April 14, 2011, by the following vote: Yeas 31, Nays 0. | ||
| ______________________________ | ||
| Secretary of the Senate | ||
| I hereby certify that S.B. No. 554 passed the House on | ||
| May 23, 2011, by the following vote: Yeas 142, Nays 0, two | ||
| present not voting. | ||
| ______________________________ | ||
| Chief Clerk of the House | ||
| Approved: | ||
| ______________________________ | ||
| Date | ||
| ______________________________ | ||
| Governor | ||
