,,ii  #aaf? ,,congress  #b;d ,session   
,s4 #dhid  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,novemb] #ab1 #bjbj,mr4
 ,man*9 7= himself & ,mr4 ,cram]7       
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,heal?1 ,education1 ,labor1 & ,p5sions  
,a ,,bill  ,to am5d title ,,xxvii ( !   
,public ,heal? ,s]vice ,act to improve  
heal? c>e cov]age "u vision & d5tal     
plans1 & = o!r purposes4  #a4 ,%ort     
title ,?is ,act may be cit$ z ! ,d5tal &
 ,optometric ,c>e ,access ,act ( #bjai  
or ! ,,doc ,access ,act ( #bjai4  #b4   
,improv+ heal? c>e cov]age "u vision &  
d5tal plans  7a7 ,9 g5]al ,title ,,xxvii
 ( ! ,public ,heal? ,s]vice ,act is     
am5d$ by ins]t+ aft] section #bgai;,a   
7#db ,u4,s4,c4 #cjj;gg-#ai;a7 ! foll[+  
new section3  #bgai;,b4 ,improv+ cov]age
 "u vision & d5tal plans  7a7 ,9 g5]al  
,"u a gr\p heal? plan or individual or  
gr\p heal? insurance cov]age 7includ+   
su* a plan or cov]age (f]+ limit$ scope 
d5tal or vision b5efits71 ! foll[+ %all 

apply3 7#a7 ,paym5t am\nts f cov]$      
p]sons  7,a7 ,9 g5]al ,! plan or cov]age
 %all provide t1 ) respect to a doctor (
 optometry1 doctor ( d5tal surg]y1 or   
doctor ( d5tal m$ic9e t has an agreem5t 
to p>ticipate 9 ! plan or cov]age & t   
provides items or s]vices t are n cov]$ 
s]vices "u ! plan or cov]age to a p]son 
enroll$ "u su* plan or cov]age1 ! doctor
 may *>ge ! enrollee = su* items or     
s]vices any am\nt det]m9$ by ! doctor t 
is equal to1 or less ?an1 ! usual &     
cu/om>y am\nt t ! doctor *>ges          
individuals :o are n s enroll$ = su*    
items or s]vices4  7,b7 ,items or       
s]vices consid]$ cov]$ by a plan ,=     
purposes ( subp>agraph 7,a71 an item or 
s]vice %all be consid]$1 ) respect to a 
plan or cov]age1 to be cov]$ s]vices "u 
! plan or cov]age only if ! item or     
s]vice is an item or s]vice ) respect to
 :i* ! plan or cov]age is obligat$ to   
pay an am\nt t is reasonable & is n     
nom9al or de m9imis4  7,c7 ,exception = 
d5tal clean+ ,= purposes ( subp>agraph  

7,a71 a doctor ( d5tal surg]y or doctor 
( d5tal m$ic9e t has an agreem5t to     
p>ticipate 9 ! plan or cov]age may *>ge 
an enrollee only ! contract$ network fee
 = any d5tal clean+1 includ+ any d5tal  
clean+ t exce$s ! annual maximum "u !   
enrollee's plan or cov]age4  7#b7       
,duration ( limit$ scope vision & d5tal 
plans ,9 ! case ( an agreem5t betwe5 su*
 a doctor & su* a plan or cov]age t (f]s
 limit$ scope d5tal or vision b5efits-- 
7,a7 ! agreem5t may be ext5d$ = a t]m   
long] ?an #b ye>s only ) ! prior        
acceptance ( ! doctor = ea* su* t]m     
ext5sion2 &  7,b7 ! agreem5t may be     
ext5d$ = unlimit$ t]ms1 subject to      
subp>agraph 7,a74  7#c7 ,no re/rictions 
on *oice ( laboratories ,! plan or      
cov]age may n1 directly or indirectly1  
re/rict or limit1 su* a doctor's *oice (
 laboratories or *oice ( s\rce &        
suppli]s ( s]vices or mat]ials provid$  
by ! doctor to an individual :o is      
enroll$ "u ! plan or cov]age4  7b7      
,private "r ( action ,9 addition to any 

o!r rem$ies "u ,/ate or ,f$]al law1 a   
p]son adv]sely affect$ by a violation ( 
?is subsection may br+ action =         
injunctive relief aga9/ a plan describ$ 
9 subsection 7a7 &1 ^u prevail+1 9      
addition to su* injunctive relief %all  
recov] monet>y damages ( no m ?an #a1jjj
 = ea* day f\nd to be 9 violation plus  
attorney's fees & co/s4 ,! di/rict c\rts
 ( ! ,unit$ ,/ates %all h exclusive     
jurisdiction ( civil actions br\ght "u  
?is subsection4  7c7 ,relation%ip to    
exception = limit$1 except$ b5efits     
,section #bgbb7;c77#a7 %all n apply )   
respect to ! requirem5ts ( ?is section4 
7d7 ,election ,to be exclud$  7#a7 ,9   
g5]al ,if a doctor ( optometry1 doctor (
 d5tal surg]y1 or doctor ( d5tal m$ic9e 
to :i* ! provisions ( p>agraphs 7#a7 &  
7#c7 ( subsection 7a7 o!rwise apply     
makes an election "u ?is p>agraph 79 su*
 =m & mann] z ! ,secret>y may by        
regulations prescribe71 ! requirem5ts ( 
su* p>agraphs ins(> z !y apply directly 
to ! plan or cov]age %all n apply to su*

 plan or cov]age = su* p]iod1 z describ$
 9 p>agraph 7#b74  7#b7 ,p]iod (        
election ,an election "u p>agraph 7#a7--
 7,a7 %all apply = a s+le specifi$ plan 
ye>2  7,b7 may be ext5d$ ?r\gh subsequ5t
 elections "u ?is subsection2 &  7,c7   
%all n be available ) respect to !      
requirem5ts conc]n+ ! duration ( limit$ 
scope vision & d5tal plans "u subsection
 7a77#b74  7e7 ,def9itions ,9 ?is       
section3 7#a7 ,! t]m cov]$ s]vices means
 d5tal c>e or vision c>e s]vices = :i*  
reimbursem5t is available "u a plan or  
cov]age contract1 or = :i* reimbursem5t 
w\ld be available b = ! application (   
contractual limitations1 includ+        
d$uctibles1 copaym5ts1 co9surance1 wait+
 p]iods1 lifetime maximum1 frequ5cy     
limitations1 & alt]native b5efit        
paym5ts4  7#b7 ,! t]ms doctor ( d5tal   
surg]y & doctor ( d5tal m$ic9e mean a   
doctor ( d5tal surg]y or ( d5tal m$ic9e1
 z applicable1 :o is legally au?oriz$ to
 practice d5ti/ry by ! ,/ate 9 :i* !    
doctor p]=ms su* function & :o is act+  

)9 ! scope ( ! lic5se ( ! doctor :5     
p]=m+ su* functions4  7#c7 ,! t]m doctor
 ( optometry means a doctor ( optometry 
:o is legally au?oriz$ to practice      
optometry by ! ,/ate 9 :i* ! doctor s   
practices4  4  7b7 ,con=m+ am5dm5t      
,section #bgbb7;c77#a7 ( ! ,public      
,heal? ,s]vice ,act 7#db ,u4,s4,c4      
#cjj;gg-#ba7;c77#a77 is am5d$ by /rik+  
,! requirem5ts & ins]t+ ,subject to     
section #bgai;,b1 ! requirem5ts4  7c7   
,exclusive applicability ( ,/ate law    
,not)/&+ any am5dm5t made by ?is ,act1  
,/ate law t directly affects any /&>d or
 requirem5t relat+ to heal? insurance   
issu]s & d5tal or vision b5efit plans1  
%all h exclusive application & !        
am5dm5ts made by ?is ,act %all n apply  
to ! ext5t t su* ,/ate law conflicts )  
su* am5dm5ts4 ,! ,/ate %all reta9       
exclusive jurisdiction ov] heal?        
insurance issu]s & limit$ scope d5tal or
 vision b5efit plans t are directly     
gov]n$ by su* ,/ate4