BILL ANALYSIS
Senate Research Center |
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AUTHOR'S / SPONSOR'S STATEMENT OF INTENT
At this time, 16 state have enacted legislation to prevent caps on non-covered services. A non-covered service is considered to be any service for which the third-party contract provides either no benefit or no reimbursement, including services that exceed the annual or lifetime maximums and services provided during waiting periods.
RULEMAKING AUTHORITY
This bill does not expressly grant any additional rulemaking authority to a state officer, institution, or agency.
SECTION BY SECTION ANALYSIS
SECTION 1. Amends Subchapter I, Chapter 843, Insurance Code, by adding Section 843.3115, as follows:
Sec. 843.3115. CONTRACTS WITH DENTISTS. (a) Defines, in this section, "covered service."
(b) Prohibits a contract between a health maintenance organization and a dentist from limiting the fee the dentist may charge for a service that is not a covered service.
SECTION 2. Amends Subchapter E, Chapter 1451, Insurance Code, by adding Section 1451.2065, as follows:
Sec. 1451.2065. CONTRACTS WITH DENTISTS. (a) Defines, in this section, "covered service."
(b) Prohibits a contract between an insurer and a dentist from limiting the fee the dentist may charge for a service that is not a covered service.
SECTION 3. Makes application of Sections 843.3115 and 1451.2065, Insurance Code, as added by this Act, prospective.
SECTION 4. Effective date: September 1, 2011.