SRC-JXG S.B. 1084 76(R)   BILL ANALYSIS


Senate Research Center   S.B. 1084
By: Harris
Health Services
5/10/1999
As Filed


DIGEST 

Currently, Article 3.51-6, Insurance Code, applies to group health
insurance policies, and is the only statute that addresses assignment of
benefits.  This statute applies to medical services and not dental
services.  This creates a problem for the insured, because there are cases
when an insurance plan allows a patient to go outside the network but does
not assign the benefits to the patient's doctor. As a result, a  patient
must pay out-of-pocket and then be reimbursed by the insurance company.
S.B. 1084 would assign benefits to the insured, and would make this statute
clearly apply to dental services. 

PURPOSE

As proposed, S.B. 1084 shifts the option to assign benefits to the insured,
and makes this statute clearly apply to dental services. 

RULEMAKING AUTHORITY

This bill does not grant any additional rulemaking authority to a state
officer, institution, or agency. 

SECTION BY SECTION ANALYSIS

SECTION 1. Amends Section 1, Article 21.53, Insurance Code, to redefine
"health insurance policy" and "employee benefit plan."  

SECTION 2. Amends Section 3, Article 21.53, Insurance Code, and by adding
Subsection (c), as follows:  

Sec. 3. MANDATORY PROVISIONS. Requires any health insurance policy or
employee benefit plan, to the extent that it provides benefits for dental
care services, to provide that the party to or beneficiary of the health
insurance policy or employee benefit plan may assign the right to benefits
to the dentist who provides the dental care services, in which case,
benefits shall 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; however, if the party to or beneficiary of the
health insurance policy or employee benefit plan makes an assignment under
this section, but the payor, after receiving a copy of the assignment, pays
the benefits to such party or beneficiary, the payor shall also pay those
benefits to the dentist who received the assignment as soon as the payor
receives notice of the incorrect payment. Makes a conforming change. 

SECTION 3. Amends Section 3, Article 3.51-6, Insurance Code, to require all
benefits under any group or blanket accident and sickness policy to be
payable to the person insured, or to the designated beneficiary or
beneficiaries, or estate, except as otherwise provided in this section.
Requires the 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; however, if the insured makes an assignment under this
subsection, but the insurer, after receiving a copy of the assignment, pays
the benefits to the insured, the insurer shall also pay those benefits to
the provider of dental care services  who received the assignment as soon
as the insurer receives notice of the incorrect payment. Prohibits the
policy from requiring that a covered service be rendered by a particular
hospital or person.  Deletes text prohibiting the policy from requiring
that the service be rendered by a particular hospital or person. Makes a
conforming change. 

SECTION 4. Emergency clause.
           Effective date: upon passage.