Sec. 843.3115. CONTRACTS WITH DENTISTS. (a) In this section, "covered service" means a dental care service for which reimbursement is available under an enrollee's health care plan contract, or for which reimbursement is available subject to a contractual limitation, including:
(1) a deductible;
(2) a copayment;
(3) coinsurance;
(4) a waiting period;
(5) an annual or lifetime maximum limit;
(6) a frequency limitation; or
(7) an alternative benefit payment.
(b) A contract between a health maintenance organization and a dentist may not limit the fee the dentist may charge for a service that is not a covered service.
Added by Acts 2011, 82nd Leg., R.S., Ch. 1061 (S.B. 554), Sec. 1, eff. September 1, 2011.
Structure Texas Statutes
Title 6 - Organization of Insurers and Related Entities
Subtitle C - Life, Health, and Accident Insurers and Related Entities
Chapter 843 - Health Maintenance Organizations
Subchapter I. Relations With Physicians and Providers
Section 843.301. Practice of Medicine Not Affected
Section 843.303. Denial of Initial Contract to Physician or Provider
Section 843.304. Exclusion of Provider Based on Type of License Prohibited
Section 843.3041. Acupuncturist Services
Section 843.3042. Chiropractic Services
Section 843.3045. Nurse First Assistant
Section 843.305. Annual Application Period for Physicians and Providers to Contract
Section 843.306. Termination of Participation; Advisory Review Panel
Section 843.307. Expedited Review Process on Termination or Deselection
Section 843.308. Notification of Patients of Deselected Physician or Provider
Section 843.310. Contracts With Physicians or Providers: Certain Indemnity Clauses Prohibited
Section 843.311. Contracts With Podiatrists
Section 843.3115. Contracts With Dentists
Section 843.312. Physician Assistants and Advanced Practice Nurses
Section 843.313. Economic Profiling
Section 843.314. Inducement to Limit Medically Necessary Services Prohibited
Section 843.315. Payment of Capitation; Assignment of Primary Care Physician or Provider
Section 843.316. Alternative Capitation System
Section 843.318. Certain Contracts of Participating Physician or Provider Not Prohibited
Section 843.319. Certain Required Contracts
Section 843.320. Use of Hospitalist
Section 843.321. Availability of Coding Guidelines
Section 843.323. Contract Provisions Prohibiting Rejection of Batched Claims