H.R. 1521 — DOC Access Act of 2025

This section inserts new section 2719B in the Public Health Service Act (after section 2719A) to impose requirements on group health plans and individual or group health insurance coverage, including limited scope dental or vision benefits. Such plans or coverage must (1) permit participating doctors of optometry, dental surgery, or dental medicine (or employing entities) to charge enrollees for non-covered items or services within the providers' scope of practice up to their usual and customary rates for non-enrollees—with covered services defined as those obligating reasonable (non-nominal or de minimis) payment by the plan, and dental cleanings limited to the contracted network fee even if exceeding annual maximums; (2) allow agreements for limited scope dental or vision benefits to extend beyond two years only with prior provider acceptance (and for unlimited terms subject to that condition); and (3) refrain from restricting providers' choice of laboratories, sources, or suppliers for items or services within their scope of practice. The section further directs the Secretary to annually notify states of their enforcement authority under section 2723(a)(1) and treat non-responsive or non-enforcing states as failing to substantially enforce under section 2723(a)(2) and (b); clarifies that the excepted benefits exception under section 2722(c)(1) does not apply; allows affected providers to elect exclusion from requirements (1) and (3) for a specified plan year (extendable, but not for requirement (2)); and defines key terms. This section also amends section 2722(c)(1) conforming to the new requirements and specifies that conflicting state laws directly affecting health insurance issuers or dental/vision benefit plans have exclusive applicability.