HBA-ATS S.B. 1084 76(R) BILL ANALYSIS Office of House Bill AnalysisS.B. 1084 By: Harris Insurance 5/21/1999 Engrossed BACKGROUND AND PURPOSE Article 3.51-6(3) (Payment of Benefits), Insurance Code, addresses the assignment of benefits under any group or blanket accident sickness policy. All benefits are required to be payable to the insured, or to the insured's designated beneficiary or beneficiaries, or to the insured's estate, except that in the case of an insured minor, such benefits may be made payable to the minor's parent, guardian, or other person actually supporting the minor. The statute does authorize the policy to provide that all or a portion of any indemnities provided by any such policy on account of hospital, nursing, medical, or surgical services may, at the option of the insurer and unless the insured requests otherwise in writing not later than the time of filing proofs of such loss, be paid directly to the hospital or person rendering such services, however. Such a payment discharges the obligation of the insurer with respect to the amount of insurance paid. Because the statute applies only to medical services, the exclusion of dental services may create a problem for an insured in situations in which the insurance plan permits a patient to go outside the network but does not assign the benefits to the patient's dentist. Consequently, a patient must pay out-of-pocket and be reimbursed by the patient's insurer. S.B. 1084 requires any group or blanket accident sickness policy to provide that all or a portion of any benefits provided by any such policy for dental care services may, at the option of the insured, be assigned to the dentist providing such services. In the case of such assignment, the payment is required to be made directly to the dentist designated. A payment made pursuant to such assignment discharges the obligation of the insurer with respect to the amount of insurance so paid. The policy is prohibited from requiring that a covered service be rendered by a particular hospital or person. In addition, this bill deletes text prohibiting any group or blanket accident and sickness policy from requiring that a medical service be rendered by a particular hospital or person, and redefines "health insurance policy" and "employee benefit plan." RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that this bill does not expressly delegate any additional rulemaking authority to a state officer, department, agency, or institution. SECTION BY SECTION ANALYSIS SECTION 1. Amends Article 21.53(1), Insurance Code, to redefine "health insurance policy" by deleting the provision that the policy provides benefits for dental care expenses incurred as a result of an accident or sickness and by specifying that the plan provides benefits for dental care services. Redefines "employee benefit plan" by deleting the provision that the plan provides dental care benefits in the event of an accident or sickness and by specifying that the plan provides benefits for dental care services. SECTION 2. Amends Article 21.53(3), Insurance Code, to require any health insurance policy (policy) or employee benefit plan (plan) to provide that the party to or beneficiary of the policy or plan is authorized to assign the right to benefits to the dentist who provides the dental care services, in which case, benefits are required to be paid directly to the dentist designated. Provides that a payment made pursuant to this subsection discharges the payor's obligation to pay those benefits. Makes conforming changes. SECTION 3. Amends Article 3.51-6(3), Insurance Code, by deleting text prohibiting any group or blanket accident and sickness policy from requiring that certain services be rendered by a particular hospital or person, and by adding an exception to the requirement that all benefits under any group or blanket accident and sickness policy be payable to the person insured, or to the designated beneficiary or beneficiaries, or estate. The exception requires any such policy to provide that all or a portion of any benefits provided by any such policy for dental care services may, at the option of the insured, be assigned to the dentist providing such services; requires the payment to be made directly to the dentist designated, in the case of such assignment; requires a payment made pursuant to such assignment to discharge the obligation of the insurer with respect to the amount of insurance so paid; and prohibits the policy from requiring that a covered service be rendered by a particular hospital or person. Makes a conforming change. SECTION 4.Emergency clause. Effective date: upon passage.