bill ends equal pay for out-of-network dentists

The text as introduced · 289 words

90R1325 RDS-F

By: Lalani
H.B. No. 515

A BILL TO BE ENTITLED

AN ACT

relating to the payments and reimbursements for noncontracting and

contracting provider dentists under certain health benefit plans.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Section 1451.206(a), Insurance Code, is amended

to read as follows:

(a) The employee benefit plan or health insurance policy

shall:

(1) provide:

(A) [ that payment or reimbursement for a

noncontracting provider dentist shall be the same as payment or

reimbursement for a contracting provider dentist;

[ (B) ] that the party to or beneficiary of the

plan or policy may assign the right to payment or reimbursement to

the dentist who provides the dental care services; and

(B) [ (C) ] one or more methods of payment or

reimbursement that provide the dentist 100 percent of the

contracted amount of the payment or reimbursement and that do not

require the dentist to incur a fee to access the payment or

reimbursement; and

(2) disclose on the Internet website required under

Section 1451.205 and on request of a dentist or a party to or

beneficiary of the plan or policy the fees, if any, associated with

the methods of payment or reimbursement available under the plan or

policy.

SECTION 2. Section 1451.206, Insurance Code, as amended by

this Act, applies only to a health benefit plan delivered, issued

for delivery, or renewed on or after January 1, 2028. A plan

delivered, issued for delivery, or renewed before January 1, 2028,

is governed by the law as it existed immediately before the

effective date of this Act, and that law is continued in effect for

that purpose.

SECTION 3. This Act takes effect September 1, 2027.