DOC Access Act of 2025
Summary
What This Bill Does
The DOC Access Act adds a federal rule for group and individual health coverage, including limited-scope dental and vision benefits. A dental or vision plan could not force a participating dentist, optometrist, or related provider entity to accept a plan-set fee for a service the plan does not actually cover. A service counts as covered only if the plan pays a significant amount for it. For noncovered services, the provider may charge up to the usual and customary amount charged to people who are not enrolled in the plan. The bill is a provider-contracting bill: it limits insurer fee schedules for noncovered care rather than mandating new dental or vision benefits.
Who Benefits and How
Dentists benefit because plan contracts could no longer cap their charges for noncovered dental services below their usual rates. Optometrists benefit because vision plans could not impose fee limits on services the plan does not significantly pay for. Dental practices benefit from stronger negotiating leverage over insurer network contracts. Vision practices benefit when noncovered exams, materials, or procedures can be priced outside plan fee schedules.
Who Bears the Burden and How
Dental insurers bear compliance burden because they must remove or revise noncovered-service fee caps in provider contracts. Vision insurers bear compliance burden because limited-scope vision plans must respect the same provider-pricing rule. Plan enrollees may pay more out of pocket for noncovered services if provider charges rise to usual and customary amounts. Employer plan sponsors may face complaints or network-contract adjustments tied to noncovered dental and vision costs.
Key Provisions
- Prohibits plan-imposed provider fee caps for noncovered dental and vision services.
- Defines a covered service by whether the plan pays a significant amount.
- Authorizes providers to charge usual and customary amounts for noncovered services.
- Applies the rule to group coverage, individual coverage, and limited-scope dental or vision benefits.
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers with clause-level evidence links.
At a Glance
What This Bill Does
Bars dental and vision plans from capping what participating dentists or optometrists may charge patients for services the plan does not cover, unless the plan pays a significant amount for the service.
Key Policy Areas
Health Insurance, Dental Care, Vision Care
Primary Purpose
Bars dental and vision plans from capping what participating dentists or optometrists may charge patients for services the plan does not cover, unless the plan pays a significant amount for the service.
Policy Domains
Resolution provisions
Identified Gains
- Dentists
- Optometrists
- Dental practices
- Vision practices
Identified Costs
- Dental insurers
- Vision insurers
- Plan enrollees
- Employer plan sponsors
Sponsors
Legislative Progress
In CommitteeMr. Carter of Georgia (for himself and Ms. Clarke of …
Referred to the House Committee on Energy and Commerce.
Introduced in House
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology