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A BILL TO BE ENTITLED
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AN ACT
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relating to contracts between dentists, optometrists, or |
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therapeutic optometrists and health maintenance organizations or |
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insurers. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 843.3115, Insurance Code, is amended to |
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read as follows: |
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Sec. 843.3115. CONTRACTS WITH DENTISTS, OPTOMETRISTS, OR |
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THERAPEUTIC OPTOMETRISTS. (a) In this section, "covered product |
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or service" means a dental care service or vision care product or |
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service for which reimbursement is available under an enrollee's |
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health care plan contract, 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 a health maintenance organization |
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and a dentist, optometrist, or therapeutic optometrist may not |
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limit the fee the dentist, optometrist, or therapeutic optometrist |
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may charge for a product or service that is not a covered product or |
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service. |
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(c) A contract between a health maintenance organization |
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and a dentist, optometrist, or therapeutic optometrist may not |
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require a discount on a product or service that is not a covered |
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product or service. |
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SECTION 2. The heading to Subchapter E, Chapter 1451, |
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Insurance Code, is amended to read as follows: |
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SUBCHAPTER E. DENTAL AND VISION CARE BENEFITS IN HEALTH INSURANCE |
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POLICIES OR EMPLOYEE BENEFIT PLANS |
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SECTION 3. Section 1451.201, Insurance Code, is amended by |
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adding Subdivision (4) to read as follows: |
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(4) "Vision care product or service" means a product |
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or service provided within the scope of the practice of optometry or |
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therapeutic optometry under Chapter 351, Occupations Code. |
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SECTION 4. Section 1451.2065, Insurance Code, is amended to |
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read as follows: |
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Sec. 1451.2065. CONTRACTS WITH DENTISTS, OPTOMETRISTS, OR |
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THERAPEUTIC OPTOMETRISTS. (a) In this section, "covered product |
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or service" means a dental care service or vision care product or |
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service for which reimbursement is available under a patient's |
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employee benefit plan or health insurance policy, or for which |
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reimbursement is available subject to a contractual limitation, |
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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, |
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optometrist, or therapeutic optometrist may not limit the fee the |
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dentist, optometrist, or therapeutic optometrist may charge for a |
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product or service that is not a covered product or service. |
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(c) A contract between an insurer and a dentist, |
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optometrist, or therapeutic optometrist may not require a discount |
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on a product or service that is not a covered product or service. |
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SECTION 5. The change in law made by this Act applies only |
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to a contract entered into or renewed on or after January 1, 2014. A |
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contract entered into or renewed before January 1, 2014, 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 6. This Act takes effect September 1, 2013. |