DOC Access Act of 2025

This bill aims to improve health care coverage under vision and dental plans by amending the Public Health Service Act. It introduces new provisions designed to give healthcare providers more autonomy in their agreements with health plans and to clarify billing practices for services not fully covered. The legislation focuses on payment amounts , contract durations , and provider choice of laboratories . Specifically, the bill mandates that group health plans and individual health insurance coverage must allow optometrists and dentists to charge enrollees their usual and customary amounts for items or services not covered by the plan. An exception is made for dental cleanings, where dentists may only charge the contracted network fee , even if it exceeds the plan's annual maximum. Furthermore, plans cannot restrict a provider's choice of laboratories or suppliers for materials and services. Regarding contract duration, agreements between providers and limited scope dental or vision plans can only be extended beyond two years with the provider's prior acceptance for each extension. The Secretary of Health and Human Services is required to annually notify states of their authority to enforce these provisions. Importantly, the bill stipulates that existing state laws directly affecting health insurance issuers and dental or vision benefit plans shall have exclusive application , meaning federal amendments will not apply if they conflict with state law.