AN ACT
 1-1     relating to the assignment of benefits for dental care services.
 1-2           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
 1-3           SECTION 1.  Section 1, Article 21.53, Insurance Code, is
 1-4     amended to read as follows:
 1-5           Sec. 1.  Definitions.  As used in this article:
 1-6           (a)  "health insurance policy" means any individual, group,
 1-7     blanket, or franchise insurance policy, insurance agreement, or
 1-8     group hospital service contract providing benefits for dental care
 1-9     services [expenses incurred as a result of an accident or
1-10     sickness];
1-11           (b)  "employee benefit plan" means any plan, fund, or program
1-12     heretofore or hereafter established or maintained by an employer or
1-13     by an employee organization, or by both, to the extent that such
1-14     plan, fund, or program was established or is maintained for the
1-15     purpose of providing for its participants or their beneficiaries,
1-16     through the purchase of insurance or otherwise, [dental care]
1-17     benefits for dental care services [in the event of accident or
1-18     sickness];
1-19           (c)  "dental care services" means any services furnished to
1-20     any person for the purpose of preventing, alleviating, curing, or
1-21     healing human dental illness or injury;
1-22           (d)  "dentist" means any person who furnishes dental care
1-23     services and who is licensed as a dentist by the State of Texas.
1-24           SECTION 2.  Section 3, Article 21.53, Insurance Code, is
 2-1     amended to read as follows:
 2-2           Sec. 3.  Mandatory Provisions.  Any health insurance policy
 2-3     or employee benefit plan which is delivered, renewed, issued for
 2-4     delivery, or otherwise contracted for in this state shall, to the
 2-5     extent that it provides benefits for dental care services
 2-6     [expenses]:
 2-7           (a)  disclose, if applicable, that the benefit offered is
 2-8     limited to the least costly treatment;
 2-9           (b)  define and explain the standard upon which the payment
2-10     of benefits or reimbursement for the cost of dental care services
2-11     is based, such as "usual and customary," "reasonable and
2-12     customary," "usual, customary, and reasonable," fees or words of
2-13     similar import or specify in dollars and cents the amount of the
2-14     payment or reimbursement for dental care services to be provided.
2-15     Said payment or reimbursement for a noncontracting provider dentist
2-16     shall be the same as the payment or reimbursement for a contracting
2-17     provider dentist; provided, however, that the health insurance
2-18     policy or the employee benefit plan shall not be required to make
2-19     payment or reimbursement in an amount which is greater than the
2-20     amount so specified or which is greater than the fee charged by the
2-21     providing dentist for the dental care services rendered; and
2-22           (c)  provide that the party to or beneficiary of the health
2-23     insurance policy or employee benefit plan may assign the right to
2-24     benefits to the dentist who provides the dental care services, in
2-25     which case, benefits shall be paid directly to the dentist
2-26     designated.  A payment made pursuant to this subsection discharges
 3-1     the payor's obligation to pay those benefits.
 3-2           SECTION 3.  Section 3, Article 3.51-6, Insurance Code, is
 3-3     amended to read as follows:
 3-4           Sec. 3.  Payment of Benefits.  Except as otherwise provided
 3-5     in this section, all [All] benefits under any group or blanket
 3-6     accident and sickness policy shall be payable to the person
 3-7     insured, or to his designated beneficiary or beneficiaries, or to
 3-8     his estate, except that if the person insured be a minor or
 3-9     otherwise not competent to give a valid release, such benefits may
3-10     be made payable to his parent, guardian, or other person actually
3-11     supporting him.  The policy may provide that all or a portion of
3-12     any indemnities provided by any such policy on account of hospital,
3-13     nursing, medical, or surgical services may, at the option of the
3-14     insurer and unless the insured requests otherwise in writing not
3-15     later than the time of filing proofs of such loss, be paid directly
3-16     to the hospital or person rendering such services[; but the policy
3-17     may not require that the service be rendered by a particular
3-18     hospital or person].  Payment so made shall discharge the
3-19     obligation of the insurer with respect to the amount of insurance
3-20     so paid.  The policy shall provide that all or a portion of any
3-21     benefits provided by any such policy for dental care services may,
3-22     at the option of the insured, be assigned to the dentist providing
3-23     such services.  In the case of such assignment, payment shall be
3-24     made directly to the dentist designated.  A payment made pursuant
3-25     to such assignment shall discharge the obligation of the insurer
3-26     with respect to the amount of insurance so paid.  The policy may
 4-1     not require that a covered service be rendered by a particular
 4-2     hospital or person.
 4-3           SECTION 4.  The importance of this legislation and the
 4-4     crowded condition of the calendars in both houses create an
 4-5     emergency and an imperative public necessity that the
 4-6     constitutional rule requiring bills to be read on three several
 4-7     days in each house be suspended, and this rule is hereby suspended,
 4-8     and that this Act take effect and be in force from and after its
 4-9     passage, and it is so enacted.
         _______________________________     _______________________________
             President of the Senate              Speaker of the House
               I hereby certify that S.B. No. 1084 passed the Senate on
         May 17, 1999, by the following vote:  Yeas 30, Nays 0.
                                             _______________________________
                                                 Secretary of the Senate
               I hereby certify that S.B. No. 1084 passed the House on
         May 26, 1999, by the following vote:  Yeas 144, Nays 0, two present
         not voting.
                                             _______________________________
                                                 Chief Clerk of the House
         Approved:
         _______________________________
                     Date
         _______________________________
                   Governor