{"data":{"id":"us-tx/tex.-insurance-code-1451.2065","jurisdiction":"us-tx","citation":"Tex. Insurance Code § 1451.2065","heading":"CONTRACTS WITH DENTISTS.","body":"(a) In this section:\n(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:\n(A) a deductible;\n(B) a copayment;\n(C) coinsurance;\n(D) a waiting period;\n(E) an annual or lifetime maximum limit;\n(F) a frequency limitation;\n(G) an alternative benefit payment; or\n(H) any other limitation.\n(2) \"Insurer\" means a provider or issuer of an employee benefit plan or health insurance policy.\n(b) A contract between an insurer and a dentist may not:\n(1) limit the fee the dentist may charge for a service that is not a covered service; or\n(2) include a provision that both:\n(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\n(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.\nAdded by Acts 2011, 82nd Leg., R.S., Ch. 1061 (S.B. 554), Sec. 2, eff. September 1, 2011.\nAmended by:\nActs 2023, 88th Leg., R.S., Ch. 1002 (H.B. 1527), Sec. 2, eff. September 1, 2023.","path":["INSURANCE CODE","TITLE 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES","SUBTITLE F. PHYSICIANS AND HEALTH CARE PROVIDERS","CHAPTER 1451. ACCESS TO CERTAIN PRACTITIONERS AND FACILITIES","SUBCHAPTER E. DENTAL CARE BENEFITS IN HEALTH INSURANCE POLICIES OR EMPLOYEE BENEFIT PLANS"],"source_url":"https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1451.htm#1451.2065","current_through":"89th 2nd Called Legislative Session, 2025","vintage":"","retrieved_at":"2026-08-27T01:47:21Z","sha256":"ed3ed47ac85de1f128311af62235081f5d1f60510b98f10f36597ebba2dfeb22","source_id":"us-tx","stale":false,"prev":"us-tx/tex.-insurance-code-1451.206","next":"us-tx/tex.-insurance-code-1451.207"},"notice":"GroundRules: Original legal text. Not legal advice."}