By: Harris S.B. No. 1084
A BILL TO BE ENTITLED
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.