Tex. Ins. Code § 1451.2065

Current with legislation from the 2023 Regular and Special Sessions signed by the Governor as of November 21, 2023.

Section 1451.2065 - Contracts With Dentists

(a) In this section:

(1) "Covered service" means a dental care service for which reimbursement is available under a patient's employee benefit plan or health insurance policy, or for which reimbursement is available subject to a contractual limitation, including:

(A) a deductible;

(B) a copayment;

(C) coinsurance;

(D) a waiting period;

(E) an annual or lifetime maximum limit;

(F) a frequency limitation;

(G) an alternative benefit payment; or

(H) any other limitation.

(2) "Insurer" means a provider or issuer of an employee benefit plan or health insurance policy.

(b) A contract between an insurer and a dentist may not:

(1) limit the fee the dentist may charge for a service that is not a covered service; or

(2) include a provision that both:

(A) allows the insurer to disallow a service, resulting in denial of payment to the dentist for a service that ordinarily would have been covered; and

(B) prohibits the dentist from billing for and collecting the amount owed from the patient for that service if there is a dental necessity, as defined by Section 32.054, Human Resources Code, for that service.

Tex. Ins. Code § 1451.2065

Amended by Acts 2023, Texas Acts of the 88th Leg.- Regular Session, ch. 1002,Sec. 2, eff. 9/1/2023, app. 1/1/2024.

Added by Acts 2011, 82nd Leg., R.S., Ch. 1061, Sec. 2, eff. 9/1/2011.

See Acts 2023, Texas Acts of the 88th Leg.- Regular Session, ch. 1002, Sec. 4.

This section is set out more than once due to postponed, multiple, or conflicting amendments.