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A BILL TO BE ENTITLED
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AN ACT
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relating to contracts between dentists and health maintenance |
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organizations or insurers. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter I, Chapter 843, Insurance Code, is |
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amended by adding Section 843.3115 to read as follows: |
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Sec. 843.3115. CONTRACTS WITH DENTISTS. (a) In this |
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section, "covered service" means a dental care service for which |
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reimbursement is available under an enrollee's health care plan |
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contract, or for which reimbursement is available subject to a |
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contractual limitation, including: |
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(1) a deductible; |
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(2) a copayment; |
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(3) coinsurance; |
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(4) a waiting period; |
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(5) an annual or lifetime maximum limit; |
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(6) a frequency limitation; or |
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(7) an alternative benefit payment. |
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(b) A contract between a health maintenance organization |
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and a dentist may not limit the fee the dentist may charge for a |
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service that is not a covered service. |
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SECTION 2. Subchapter E, Chapter 1451, Insurance Code, is |
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amended by adding Section 1451.2065 to read as follows: |
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Sec. 1451.2065. CONTRACTS WITH DENTISTS. (a) In this |
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section, "covered service" means a dental care service for which |
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reimbursement is available under a patient's employee benefit plan |
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or health insurance policy, or for which reimbursement is available |
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subject to a contractual limitation, including: |
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(1) a deductible; |
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(2) a copayment; |
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(3) coinsurance; |
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(4) a waiting period; |
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(5) an annual or lifetime maximum limit; |
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(6) a frequency limitation; or |
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(7) an alternative benefit payment. |
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(b) A contract between an insurer and a dentist may not |
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limit the fee the dentist may charge for a service that is not a |
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covered service. |
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SECTION 3. Sections 843.3115 and 1451.2065, Insurance Code, |
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as added by this Act, apply only to a contract entered into or |
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renewed on or after the effective date of this Act. A contract |
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entered into or renewed before the effective date of this Act is |
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governed by the law in effect immediately before the effective date |
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of this Act, and that law is continued in effect for that purpose. |
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SECTION 4. This Act takes effect September 1, 2011. |