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Texas Statutes (Last Updated: January 4, 2014) |
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INSURANCE CODE |
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Title 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES |
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Subtitle F. PHYSICIANS AND HEALTH CARE PROVIDERS |
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Chapter 1451. ACCESS TO CERTAIN PRACTITIONERS AND FACILITIES |
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Subchapter E. DENTAL CARE BENEFITS IN HEALTH INSURANCE POLICIES OR EMPLOYEE BENEFIT PLANS |
Sec. 1451.206. PAYMENT OR REIMBURSEMENT OF DENTIST
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(a) The employee benefit plan or health insurance policy shall provide:
(1) that payment or reimbursement for a noncontracting provider dentist shall be the same as payment or reimbursement for a contracting provider dentist; and
(2) 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.
(b) Notwithstanding Subsection (a)(1), the employee benefit plan or health insurance policy is not required to make payment or reimbursement in an amount greater than:
(1) the amount specified in the plan or policy; or
(2) the fee the providing dentist charges for the dental care services provided.
(c) If the right to payment or reimbursement is assigned as provided by Subsection (a)(2):
(1) payment or reimbursement shall be made directly to the designated dentist; and
(2) direct payment to the designated dentist discharges the payor's obligation.