BILL ANALYSIS |
C.S.H.B. 3024 |
By: Guerra |
Insurance |
Committee Report (Substituted) |
BACKGROUND AND PURPOSE
Interested parties note that dentistry has seen a decrease in the number of private pay patients and an increase in the number of patients covered by dental insurance. Dental patients are often covered by two or more separate insurance policies that provide for dental expenses, creating conflict between the insurance policies and the dentist. C.S.H.B. 3024 seeks to provide for the coordination of benefits between the separate providers and to allow dental patients to fully benefit from coverage.
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CRIMINAL JUSTICE IMPACT
It is the committee's opinion that this bill does not expressly create a criminal offense, increase the punishment for an existing criminal offense or category of offenses, or change the eligibility of a person for community supervision, parole, or mandatory supervision.
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RULEMAKING AUTHORITY
It is the committee's opinion that this bill does not expressly grant any additional rulemaking authority to a state officer, department, agency, or institution.
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ANALYSIS
C.S.H.B. 3024 amends the Insurance Code to prohibit an insurance policy that provides benefits for dental expenses from being delivered, issued for delivery, or renewed in Texas if a provision of the policy excludes or reduces the payment of benefits for dental expenses to or on behalf of an insured, if the reason for the exclusion or reduction is that dental benefits are payable or have been paid to or on behalf of the insured under another insurance policy, and if the exclusion or reduction would apply before the full amount of the dental expenses incurred by the insured and covered by both policies have been paid or reimbursed or the full amount of the applicable policy limit of the policy containing the exclusion or reduction is reached. The bill specifies that a provision of an insurance policy that violates such conditions is void.
C.S.H.B. 3024 makes its provisions regarding dental insurance applicable only if an insured is covered by at least two different insurance policies and each policy provides the insured dental benefits. The bill establishes that the primary insurer, as determined under a coordination of benefits provision applicable to the policies, is responsible for dental expenses covered under the insurance policy issued by the primary insurer up to the full amount of any policy limit applicable to the covered dental expenses. The bill establishes that the secondary insurer, before the policy limit is reached, is responsible only for dental expenses covered under the insurance policy issued by the secondary insurer that are not covered under the policy issued by the primary insurer. The bill establishes that the secondary insurer, after the policy limit has been reached and in addition to the secondary insurer's responsibility to cover other certain dental expenses, is responsible for any dental expenses covered by both policies that exceed the policy limit.
C.S.H.B. 3024 makes its provisions regarding dental insurance applicable to certain insurance policies offered by specified types of insurers. The bill exempts from those provisions a separate dental policy that exclusively provides a non-coordinated, fixed indemnity benefit, regardless of expenses incurred paid directly to the policyholder or to the provider under an assignment of benefits provision. The bill applies only to an insurance policy delivered, issued for delivery, or renewed on or after January 1, 2016.
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EFFECTIVE DATE
September 1, 2015.
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COMPARISON OF ORIGINAL AND SUBSTITUTE
While C.S.H.B. 3024 may differ from the original in minor or nonsubstantive ways, the following comparison is organized and formatted in a manner that indicates the substantial differences between the introduced and committee substitute versions of the bill.
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