By:  Harris                                           S.B. No. 1084
         Line and page numbers may not match official copy.
         Bill not drafted by TLC or Senate E&E.
                                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:  (a)  "health
 1-6     insurance policy" means any individual, group, blanket, or
 1-7     franchise insurance policy, insurance agreement, or group hospital
 1-8     service contract providing benefits for dental care services
 1-9     [expenses incurred as a result of an accident or sickness];
1-10           (b)  "employee benefit plan" means any plan, fund or program
1-11     heretofore or hereafter established or maintained by an employer or
1-12     by an employee organization, or by both, to the extent that such
1-13     plan, fund, or program was established or is maintained for the
1-14     purpose of providing for its participants or their beneficiaries,
1-15     through the purchase of insurance or otherwise, [dental care]
1-16     benefits for dental care services [in the event of accident or
1-17     sickness];
1-18           (c)  "dental care services" means any services furnished to
1-19     any person for the purpose of preventing, alleviating, curing, or
1-20     healing human dental illness or injury;
1-21           (d)  "dentist" means any person who furnishes dental care
1-22     services and who is licensed as a dentist by the State of Texas.
 2-1           SECTION 2.  Section 3, Article 21.53, Insurance Code, is
 2-2     amended and Subsection 3(b) is added to read as follows:
 2-3           Sec. 3.  MANDATORY PROVISIONS.  Any health insurance policy
 2-4     or employee benefit plan which is delivered, renewed, issued for
 2-5     delivery, or otherwise contracted for in this state shall, to the
 2-6     extent that it provides benefits for dental care services
 2-7     [expenses];
 2-8           (c)  provide that the party to or beneficiary of the health
 2-9     insurance policy or employee benefit plan may assign the right to
2-10     benefits to the dentist who provides the dental care services, in
2-11     which case, benefits shall be paid directly to the dentist
2-12     designated.  A payment made pursuant to this subsection discharges
2-13     the payor's obligation to pay those benefits; provided, however, if
2-14     the party to or beneficiary of the health insurance policy or
2-15     employee benefit plan makes an assignment under this section, but
2-16     the payor, after receiving a copy of the assignment, pays the
2-17     benefits to such party or beneficiary, the payor shall also pay
2-18     those benefits to the dentist who received the assignment as soon
2-19     as the payor receives notice of the incorrect payment.
2-20           SECTION 3.  Section 3, Article 3.51-6, Insurance Code, is
2-21     amended to read as follows:
2-22           Sec. 3.  PAYMENT OF BENEFITS.  Except as otherwise provided
2-23     in this section, all [All] benefits under any group or blanket
2-24     accident and sickness policy shall be payable to the person
2-25     insured, or to his designated beneficiary or beneficiaries, or to
2-26     his estate, except that if the person insured be a minor or
 3-1     otherwise not competent to give a valid release, such benefits may
 3-2     be made payable to his parent, guardian, or other person actually
 3-3     supporting.  The policy may provide that all or a portion of any
 3-4     indemnities provided by any such policy on account of hospital,
 3-5     nursing, medical, or surgical services may, at the option of the
 3-6     insurer and unless the insured requests otherwise in writing not
 3-7     later than the time of filing proofs of such loss, be paid directly
 3-8     to the hospital or person rendering such services [;but the policy
 3-9     may not require that the service be rendered by a particular
3-10     hospital or person].  Payment so made shall discharge the
3-11     obligation of the insurer with respect to the amount of insurance
3-12     so paid.  The policy shall provide that all or a portion of any
3-13     benefits provided by any such policy for dental care services may,
3-14     at the option of the insured, be assigned to the dentist providing
3-15     such services.  In the case of such assignment, payment shall be
3-16     made directly to the dentist designated.  A payment made pursuant
3-17     to such assignment shall discharge the obligation of the insurer
3-18     with respect to the amount of insurance so paid; provided, however,
3-19     if the insured makes an assignment under this subsection, but the
3-20     insurer, after receiving a copy of the assignment, pays the
3-21     benefits to the insured, the insurer shall also pay those benefits
3-22     to the provider of dental care services who received the assignment
3-23     as soon as the insurer receives notice of the incorrect payment.
3-24     The policy may not require that a covered service be rendered by a
3-25     particular hospital or person.
3-26           SECTION 4.  The importance of this legislation and the
 4-1     crowded condition of the calendars in both houses create an
 4-2     emergency and an imperative public necessity that the
 4-3     constitutional rule requiring bills to be read on three several
 4-4     days in each house be suspended, and this rule is hereby suspended,
 4-5     and that this Act take effect and be in force from and after its
 4-6     passage, and it is so enacted.