By Reyna of Bexar                                     H.B. No. 1556
         77R5699 AJA-D                           
                                A BILL TO BE ENTITLED
 1-1                                   AN ACT
 1-2     relating to insurance coverage for certain dental procedures.
 1-3           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
 1-4           SECTION 1.  Section 2, Article 21.53, Insurance Code, is
 1-5     amended to read as follows:
 1-6           Sec. 2.  PROHIBITED PROVISIONS.  (a)  A [No] health insurance
 1-7     policy or employee benefit plan that [which] is delivered, renewed,
 1-8     issued for delivery, or otherwise contracted for in this state may
 1-9     not [shall]:
1-10                 (1) [(a)]  prevent any person who is a party to or
1-11     beneficiary of the [any such] health insurance policy or employee
1-12     benefit plan  from selecting the dentist of the person's [his]
1-13     choice to furnish the dental care services offered by the [said]
1-14     policy or plan or  interfere with that [said] selection if
1-15     [provided] the dentist is licensed to furnish those [such] dental
1-16     care services in this  state;
1-17                 (2) [(b)]  deny any dentist the right to participate as
1-18     a contracting provider for the [such] policy or plan if  [provided]
1-19     the dentist is licensed to furnish the dental care services offered
1-20     by the [said] policy or plan;
1-21                 (3) [(c)]  authorize any person to regulate, interfere,
1-22     or intervene in any manner in the diagnosis or treatment rendered
1-23     by a dentist to the dentist's [his] patient for the purpose of
1-24     preventing, alleviating, curing, or healing dental illness or
 2-1     injury if the [provided said] dentist practices within the scope of
 2-2     the dentist's [his] license;  [or]
 2-3                 (4) [(d)]  require that a [any] dentist furnishing
 2-4     dental care services must make or obtain dental x-rays or any other
 2-5     diagnostic aids for the purpose of preventing, alleviating, curing,
 2-6     or healing dental illness or injury; or
 2-7                 (5)  limit benefits for dental care services relating
 2-8     to the diagnosis, preparation, and fitting of a  dental crown on a
 2-9     particular tooth to one dental crown for that tooth in a specified
2-10     period [provided, however, that nothing herein shall prohibit
2-11     requests for existing dental x-rays or any other existing
2-12     diagnostic aids for the purpose of determining benefits payable
2-13     under a health insurance policy or employee benefit plan].
2-14           (b)  Subsection (a)(4) of this section does not prohibit a
2-15     request for existing dental x-rays or any other existing diagnostic
2-16     aids to determine benefits payable under a health insurance policy
2-17     or employee benefit plan.
2-18           (c)  This section does not [Nothing herein shall] prohibit
2-19     the predetermination of benefits for dental care expenses prior to
2-20     treatment by the attending dentist.
2-21           SECTION 2.  Article 21.53, Insurance Code, as amended by this
2-22     Act, applies only to a health insurance policy or employee benefit
2-23     plan that is delivered, issued for delivery, or renewed on or after
2-24     January 1, 2002.  A policy or plan delivered, issued for delivery,
2-25     or renewed before January 1, 2002, is governed by the law as it
2-26     existed immediately before the effective date of this Act, and that
2-27     law is continued in effect for that purpose.
 3-1           SECTION 3.  This Act takes effect September 1, 2001.