1-1 By: Harris S.B. No. 1084
1-2 (In the Senate - Filed March 9, 1999; March 11, 1999, read
1-3 first time and referred to Committee on Health Services;
1-4 May 13, 1999, reported adversely, with favorable Committee
1-5 Substitute by the following vote: Yeas 5, Nays 0; May 13, 1999,
1-6 sent to printer.)
1-7 COMMITTEE SUBSTITUTE FOR S.B. No. 1084 By: Madla
1-8 A BILL TO BE ENTITLED
1-9 AN ACT
1-10 relating to the assignment of benefits for dental care services.
1-11 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-12 SECTION 1. Section 1, Article 21.53, Insurance Code, is
1-13 amended to read as follows:
1-14 Sec. 1. Definitions. As used in this article:
1-15 (a) "health insurance policy" means any individual, group,
1-16 blanket, or franchise insurance policy, insurance agreement, or
1-17 group hospital service contract providing benefits for dental care
1-18 services [expenses incurred as a result of an accident or
1-19 sickness];
1-20 (b) "employee benefit plan" means any plan, fund, or program
1-21 heretofore or hereafter established or maintained by an employer or
1-22 by an employee organization, or by both, to the extent that such
1-23 plan, fund, or program was established or is maintained for the
1-24 purpose of providing for its participants or their beneficiaries,
1-25 through the purchase of insurance or otherwise, [dental care]
1-26 benefits for dental care services [in the event of accident or
1-27 sickness];
1-28 (c) "dental care services" means any services furnished to
1-29 any person for the purpose of preventing, alleviating, curing, or
1-30 healing human dental illness or injury;
1-31 (d) "dentist" means any person who furnishes dental care
1-32 services and who is licensed as a dentist by the State of Texas.
1-33 SECTION 2. Section 3, Article 21.53, Insurance Code, is
1-34 amended to read as follows:
1-35 Sec. 3. Mandatory Provisions. Any health insurance policy
1-36 or employee benefit plan which is delivered, renewed, issued for
1-37 delivery, or otherwise contracted for in this state shall, to the
1-38 extent that it provides benefits for dental care services
1-39 [expenses]:
1-40 (a) disclose, if applicable, that the benefit offered is
1-41 limited to the least costly treatment;
1-42 (b) define and explain the standard upon which the payment
1-43 of benefits or reimbursement for the cost of dental care services
1-44 is based, such as "usual and customary," "reasonable and
1-45 customary," "usual, customary, and reasonable," fees or words of
1-46 similar import or specify in dollars and cents the amount of the
1-47 payment or reimbursement for dental care services to be provided.
1-48 Said payment or reimbursement for a noncontracting provider dentist
1-49 shall be the same as the payment or reimbursement for a contracting
1-50 provider dentist; provided, however, that the health insurance
1-51 policy or the employee benefit plan shall not be required to make
1-52 payment or reimbursement in an amount which is greater than the
1-53 amount so specified or which is greater than the fee charged by the
1-54 providing dentist for the dental care services rendered; and
1-55 (c) provide that the party to or beneficiary of the health
1-56 insurance policy or employee benefit plan may assign the right to
1-57 benefits to the dentist who provides the dental care services, in
1-58 which case, benefits shall be paid directly to the dentist
1-59 designated. A payment made pursuant to this subsection discharges
1-60 the payor's obligation to pay those benefits.
1-61 SECTION 3. Section 3, Article 3.51-6, Insurance Code, is
1-62 amended to read as follows:
1-63 Sec. 3. Payment of Benefits. Except as otherwise provided
1-64 in this section, all [All] benefits under any group or blanket
2-1 accident and sickness policy shall be payable to the person
2-2 insured, or to his designated beneficiary or beneficiaries, or to
2-3 his estate, except that if the person insured be a minor or
2-4 otherwise not competent to give a valid release, such benefits may
2-5 be made payable to his parent, guardian, or other person actually
2-6 supporting him. The policy may provide that all or a portion of
2-7 any indemnities provided by any such policy on account of hospital,
2-8 nursing, medical, or surgical services may, at the option of the
2-9 insurer and unless the insured requests otherwise in writing not
2-10 later than the time of filing proofs of such loss, be paid directly
2-11 to the hospital or person rendering such services[; but the policy
2-12 may not require that the service be rendered by a particular
2-13 hospital or person]. Payment so made shall discharge the
2-14 obligation of the insurer with respect to the amount of insurance
2-15 so paid. The policy shall provide that all or a portion of any
2-16 benefits provided by any such policy for dental care services may,
2-17 at the option of the insured, be assigned to the dentist providing
2-18 such services. In the case of such assignment, payment shall be
2-19 made directly to the dentist designated. A payment made pursuant
2-20 to such assignment shall discharge the obligation of the insurer
2-21 with respect to the amount of insurance so paid. The policy may
2-22 not require that a covered service be rendered by a particular
2-23 hospital or person.
2-24 SECTION 4. The importance of this legislation and the
2-25 crowded condition of the calendars in both houses create an
2-26 emergency and an imperative public necessity that the
2-27 constitutional rule requiring bills to be read on three several
2-28 days in each house be suspended, and this rule is hereby suspended,
2-29 and that this Act take effect and be in force from and after its
2-30 passage, and it is so enacted.
2-31 * * * * *