SEC. 2. IMPROVING HEALTH CARE COVERAGE UNDER VI-
SION AND DENTAL PLANS. 
(a) IN GENERAL.—Title XXVII of the Public Health 
Service Act is amended by inserting after section 2719A 
(42 U.S.C. 300gg–19a) the following new section: 
‘‘SEC. 2719B. IMPROVING COVERAGE UNDER VISION AND 
DENTAL PLANS. 
‘‘(a) IN GENERAL.—Under a group health plan or in-
dividual or group health insurance coverage (including 
such a plan or coverage offering limited scope dental or 
vision benefits), the following shall apply: 
‘‘(1) PAYMENT AMOUNTS FROM COVERED PER-
SONS.— 
‘‘(A) IN GENERAL.—The plan or coverage 
shall provide that, with respect to a doctor of 
optometry, doctor of dental surgery, doctor of 
dental medicine, or entity that employs such a 
doctor that has an agreement to participate in 
the plan or coverage and that provides items or 
services within the scope of practice of such a 
doctor that are not covered services under the 
plan or coverage to a person enrolled under 
such plan or coverage, such doctor or entity 
may charge the enrollee for such items or serv-
ices any amount determined by such doctor or 
entity that is equal to, or less than, the usual 
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and customary amount that such doctor or enti-
ty charges individuals who are not so enrolled 
for such items or services. 
‘‘(B) ITEMS
OR
SERVICES
CONSIDERED 
COVERED BY A PLAN.—For purposes of sub-
paragraph (A), an item or service shall be con-
sidered, with respect to a plan or coverage, to 
be covered services under the plan or coverage 
only if the item or service is an item or service 
with respect to which the plan or coverage is 
obligated to pay an amount that is reasonable 
and is not nominal or de minimis. 
‘‘(C) EXCEPTION
FOR
DENTAL
CLEAN-
ING.—For purposes of subparagraph (A), a 
doctor of dental surgery, doctor of dental medi-
cine, or entity that employs such a doctor that 
has an agreement to participate in the plan or 
coverage may charge an enrollee only the con-
tracted network fee for any dental cleaning, in-
cluding any dental cleaning that exceeds the an-
nual maximum under the enrollee’s plan or cov-
erage. 
‘‘(2) DURATION OF LIMITED SCOPE VISION AND 
DENTAL PLANS.—In the case of an agreement be-
tween such a doctor or entity and such a plan or 
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coverage that offers limited scope dental or vision 
benefits— 
‘‘(A) the agreement may be extended for a 
term longer than 2 years only with the prior ac-
ceptance of such doctor or entity for each such 
term extension; and 
‘‘(B) the agreement may be extended for 
unlimited terms, subject to subparagraph (A). 
‘‘(3) NO RESTRICTIONS ON CHOICE OF LABORA-
TORIES.—The plan or coverage may not, directly or 
indirectly, restrict or limit the laboratory or source 
or supplier of services or materials that such a doc-
tor or entity may choose with respect to items and 
services within the scope of practice of such a doctor 
that are provided by such doctor or entity to an indi-
vidual enrolled under the plan or coverage. 
‘‘(b) NOTIFICATION.—The Secretary shall on an an-
nual basis notify each State of the State’s authority to 
enforce the provisions of subsection (a) against a group 
health plan or health insurance coverage described in sub-
section (a) pursuant to section 2723(a)(1) and request 
confirmation from the State whether or not the State will 
enforce the provisions of subsection (a). If a State notifies 
the Secretary that the State will not enforce the provisions 
of subsection (a) or fails to respond within 90 days of the 
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Secretary’s request, the Secretary shall treat such State 
as failing to substantially enforce such provisions for pur-
poses of subsections (a)(2) and (b) of section 2723. 
‘‘(c) RELATIONSHIP TO EXCEPTION FOR LIMITED, 
EXCEPTED
BENEFITS.—Section 2722(c)(1) shall not 
apply with respect to the requirements of this section. 
‘‘(d) ELECTION TO BE EXCLUDED.— 
‘‘(1) IN GENERAL.—If a doctor of optometry, 
doctor of dental surgery, doctor of dental medicine, 
or entity that employs such a doctor to which the 
provisions of paragraphs (1) and (3) of subsection 
(a) otherwise apply makes an election under this 
paragraph (in such form and manner as the Sec-
retary may by regulations prescribe), the require-
ments of such paragraphs insofar as they apply di-
rectly to the plan or coverage shall not apply to such 
plan or coverage for such period, as described in 
paragraph (2). 
‘‘(2) PERIOD OF ELECTION.—An election under 
paragraph (1)— 
‘‘(A) shall apply for a single specified plan 
year; 
‘‘(B) may be extended through subsequent 
elections under this subsection; and 
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‘‘(C) shall not be available with respect to 
the requirements concerning the duration of 
limited scope vision and dental plans under sub-
section (a)(2). 
‘‘(e) DEFINITIONS.—In this section: 
‘‘(1) The term ‘covered services’ means dental 
care or vision care services for which reimbursement 
is available under a plan or coverage contract, or for 
which reimbursement would be available but for the 
application of contractual limitations, including 
deductibles, copayments, coinsurance, waiting peri-
ods, lifetime maximum, frequency limitations, and 
alternative benefit payments. 
‘‘(2) The terms ‘doctor of dental surgery’ and 
‘doctor of dental medicine’ mean a doctor of dental 
surgery or of dental medicine, as applicable, who is 
legally authorized to practice dentistry by the State 
in which the doctor performs such function and who 
is acting within the scope of the license of the doctor 
when performing such functions. 
‘‘(3) The term ‘doctor of optometry’ means a 
doctor of optometry who is legally authorized to 
practice optometry by the State in which the doctor 
so practices.’’. 
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(b) CONFORMING AMENDMENT.—Section 2722(c)(1) 
of the Public Health Service Act (42 U.S.C. 300gg– 
21(c)(1)) is amended by striking ‘‘The requirements’’ and 
inserting ‘‘Subject to section 2719B, the requirements’’. 
(c) EXCLUSIVE APPLICABILITY OF STATE LAW.— 
Notwithstanding any amendment made by this Act, State 
law that directly affects any standard or requirement re-
lating to health insurance issuers and dental or vision ben-
efit plans shall have exclusive application and the amend-
ments made by this Act shall not apply to the extent that 
such State law conflicts with such amendments. The State 
shall retain exclusive jurisdiction over health insurance 
issuers and limited scope dental or vision benefit plans 
that are directly governed by such State. 
Æ 
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