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.