By Berlanga H.R. No. 1086 74R14042 PFG-D R E S O L U T I O N 1-1 WHEREAS, The members of a dental provider plan purchase 1-2 dental care at a discounted or predetermined rate from the network 1-3 of participating dentists in the plan; however, unlike traditional 1-4 health insurance, these plans do not prepay participating dentists 1-5 or offer indemnification or reimbursement for the cost of dental 1-6 care; and 1-7 WHEREAS, Dental provider organizations in Texas recognize an 1-8 urgent need to clarify this distinction and to set firm standards 1-9 for the industry that will enable consumers to make informed 1-10 decisions about this vital component of the health care system; 1-11 now, therefore, be it 1-12 RESOLVED, That the House of Representatives of the 74th Texas 1-13 Legislature hereby recommend that the Texas Department of Insurance 1-14 in conjunction with dental provider organizations in the state 1-15 develop a clear set of guidelines and minimum standards for dental 1-16 provider organizations to adhere to in order to ensure the solvency 1-17 and efficiency of the industry and to provide adequate information 1-18 and protection to dental plan members; and, be it further 1-19 RESOLVED, That these guidelines direct each dental provider 1-20 organization in the state to make readily available a copy of the 1-21 following information to confirm its financial soundness and the 1-22 adequacy of its management and dental provider plan: a copy of its 1-23 articles of incorporation, articles of association, partnership 1-24 agreement, trust agreement, or other organizational document, 2-1 assumed name documents, and all amendments; a copy of the 2-2 organization's rules, bylaws, or similar documents regulating 2-3 internal affairs; a list of names, addresses, and official 2-4 positions of the persons in authority, including members of the 2-5 board of directors, board of trustees, executive committee, or 2-6 other governing body or committee, the principal officers if a 2-7 corporation, and the partners or members if a partnership or 2-8 association; a sample copy of the form of contract between a 2-9 dentist, other provider, marketing representative, or person in 2-10 authority; a current audited financial statement; and a description 2-11 of the geographic or metropolitan area served; and, be it further 2-12 RESOLVED, That the guidelines direct dental care providers to 2-13 furnish each member with a complete and easily understood schedule 2-14 of dental care service fees and a list of participating dentists in 2-15 the member's geographical area; the schedule should inform the 2-16 member that the dental provider plan does not constitute dental 2-17 insurance and is not a health maintenance organization contract and 2-18 that the dental provider organization does not reimburse the 2-19 dentists or indemnify its members for the cost of dental care 2-20 services; and, be it further 2-21 RESOLVED, That the guidelines direct dental provider 2-22 organizations to establish a reasonable system for the resolution 2-23 of complaints by members and to furnish information about the 2-24 complaint resolution system; and, be it further 2-25 RESOLVED, That the guidelines direct dental provider 2-26 organizations to maintain a minimum surplus of $100,000, valued 2-27 following generally accepted accounting principles, and to post a 3-1 surety bond with the state treasury in the amount of $100,000 to 3-2 secure the debts and obligations of the organization to its 3-3 members, making a copy of the bond readily available; and, be it 3-4 further 3-5 RESOLVED, That the guidelines strongly discourage a dental 3-6 provider organization from deliberately allowing the use of false 3-7 or misleading advertising, solicitations, or fee schedules and 3-8 require that an organization state in its marketing or advertising 3-9 materials that the dental provider plan does not constitute dental 3-10 insurance or a health maintenance organization contract and that 3-11 the dental provider organization does not reimburse the dentists or 3-12 indemnify its members for the cost of dental care services; and, be 3-13 it further 3-14 RESOLVED, That the Texas Department of Insurance prepare a 3-15 report on the compliance of dental provider organizations with 3-16 these guidelines, that the report be submitted to the governor, the 3-17 lieutenant governor, the speaker of the house, and the legislature 3-18 not later than August 31, 1996, and that a follow-up report be 3-19 submitted by January 15, 1997.