DOC Access Act of 2025
Sponsored By: Representative Rep. Carter, Earl L. "Buddy" [R-GA-1]
Introduced
Summary
Protects dental and vision patients from surprise charges and strengthens provider control over contracts. It creates a new federal rule that defines covered services, limits what providers can bill enrollees for noncovered items, requires provider consent for contract extensions after two years, and stops plans from forcing providers to use specific labs.
Show full summary
- Families and patients: Providers can bill enrollees for noncovered items only up to the usual amount charged to non-enrollees. For dental cleanings a participating dentist may bill only the contracted network fee even if the cleaning exceeds an annual maximum.
- Providers: Optometrists and dentists must agree to any limited-scope plan extension beyond two years. They may elect for a plan year to be excluded from many of these requirements but not from the two-year contract rule.
- Plans and insurers: Must treat services as covered when the plan is obligated to pay a reasonable and not nominal amount and cannot limit the laboratory or source of materials that a provider chooses.
- States and enforcement: The federal secretary will ask each State whether it will enforce these rules. If a State declines or does not respond within 90 days the State will be treated as not substantially enforcing them.
Your PRIA Score
Personalized for You
How does this bill affect your finances?
Sign up for a PRIA Policy Scan to see your personalized alignment score for this bill and every other piece of legislation we track. We analyze your financial profile against policy provisions to show you exactly what matters to your wallet.
Bill Overview
Analyzed Economic Effects
2 provisions identified: 0 benefits, 0 costs, 2 mixed.
New rules for dental and vision bills
This bill would set new rules for dental and vision plans and in-network dentists and eye doctors. If a service is not covered, a participating provider could bill you no more than their usual price. For any dental cleaning, you would pay only the in-network fee, even if you pass your annual maximum. Plans could not control which labs or suppliers your dentist or eye doctor uses. A service would count as covered even when plan rules like deductibles, copays, waiting periods, or frequency limits limit payment. These rules would also apply to stand-alone or limited plans; providers could opt out of the billing and lab rules for a plan year, and extensions beyond two years would need the provider’s OK each time.
State enforcement of dental and vision rules
Each year, the Secretary would ask every State if it will enforce these dental and vision rules. If a State says no, or does not answer in 90 days, the federal government would treat it as not enforcing and step in. Where a State’s insurance law conflicts, the State’s rules would control for issuers and limited dental or vision plans it governs. Protections could vary by State.
Free Policy Watch
You just read the policy. Now see what it costs you.
Pick a topic. PRIA runs your household against live legislation and sends you a free personalized readout.
Pick a topic to get started
Sponsors & CoSponsors
Sponsor
Rep. Carter, Earl L. "Buddy" [R-GA-1]
GA • R
Cosponsors
Rep. Clarke, Yvette D. [D-NY-9]
NY • D
Sponsored 2/24/2025
Malliotakis
NY • R
Sponsored 3/3/2025
Rep. Brownley, Julia [D-CA-26]
CA • D
Sponsored 3/5/2025
Rep. Wagner, Ann [R-MO-2]
MO • R
Sponsored 3/10/2025
Rep. Cherfilus-McCormick, Sheila [D-FL-20]
FL • D
Sponsored 3/10/2025
Rep. Pocan, Mark [D-WI-2]
WI • D
Sponsored 3/10/2025
Rep. Foster, Bill [D-IL-11]
IL • D
Sponsored 3/14/2025
Rep. Krishnamoorthi, Raja [D-IL-8]
IL • D
Sponsored 3/18/2025
Rep. Ramirez, Delia C. [D-IL-3]
IL • D
Sponsored 3/18/2025
Valadao
CA • R
Sponsored 3/21/2025
Bost
IL • R
Sponsored 3/21/2025
Rouzer
NC • R
Sponsored 3/21/2025
Van Drew
NJ • R
Sponsored 3/21/2025
Sessions
TX • R
Sponsored 3/21/2025
Rep. Pettersen, Brittany [D-CO-7]
CO • D
Sponsored 3/25/2025
Reschenthaler
PA • R
Sponsored 3/25/2025
Rep. Mrvan, Frank J. [D-IN-1]
IN • D
Sponsored 3/31/2025
LaHood
IL • R
Sponsored 3/31/2025
Perez
WA • D
Sponsored 3/31/2025
Simpson
ID • R
Sponsored 3/31/2025
Rep. Davids, Sharice [D-KS-3]
KS • D
Sponsored 3/31/2025
Rep. Bishop, Sanford D., Jr. [D-GA-2]
GA • D
Sponsored 4/1/2025
Rep. Schneider, Bradley Scott [D-IL-10]
IL • D
Sponsored 4/1/2025
Rep. Jackson, Jonathan L. [D-IL-1]
IL • D
Sponsored 4/1/2025
Rep. Torres, Ritchie [D-NY-15]
NY • D
Sponsored 4/1/2025
Rep. Meng, Grace [D-NY-6]
NY • D
Sponsored 4/3/2025
Rep. Castor, Kathy [D-FL-14]
FL • D
Sponsored 4/3/2025
Rep. Gottheimer, Josh [D-NJ-5]
NJ • D
Sponsored 4/7/2025
Rep. Johnson, Henry C. "Hank," Jr. [D-GA-4]
GA • D
Sponsored 4/7/2025
Womack
AR • R
Sponsored 4/7/2025
Rep. Smith, Christopher H. [R-NJ-4]
NJ • R
Sponsored 4/7/2025
Estes
KS • R
Sponsored 4/10/2025
Rep. Weber, Randy K. Sr. [R-TX-14]
TX • R
Sponsored 4/10/2025
Rep. Sorensen, Eric [D-IL-17]
IL • D
Sponsored 4/24/2025
Rutherford
FL • R
Sponsored 4/29/2025
Rep. Thompson, Glenn [R-PA-15]
PA • R
Sponsored 5/5/2025
Rep. Harder, Josh [D-CA-9]
CA • D
Sponsored 5/6/2025
Latimer
NY • D
Sponsored 5/8/2025
Rep. Quigley, Mike [D-IL-5]
IL • D
Sponsored 6/5/2025
Babin
TX • R
Sponsored 6/6/2025
Rep. Suozzi, Thomas R. [D-NY-3]
NY • D
Sponsored 6/9/2025
Rogers (KY)
KY • R
Sponsored 6/9/2025
Rep. Davis, Donald G. [D-NC-1]
NC • D
Sponsored 6/10/2025
Rep. Budzinski, Nikki [D-IL-13]
IL • D
Sponsored 6/17/2025
Del. Norton, Eleanor Holmes [D-DC-At Large]
DC • D
Sponsored 6/20/2025
Rep. Soto, Darren [D-FL-9]
FL • D
Sponsored 7/2/2025
Miller (WV)
WV • R
Sponsored 7/17/2025
Rep. Sewell, Terri A. [D-AL-7]
AL • D
Sponsored 7/17/2025
Rep. Harshbarger, Diana [R-TN-1]
TN • R
Sponsored 7/21/2025
Rep. Correa, J. Luis [D-CA-46]
CA • D
Sponsored 7/23/2025
Kelly (MS)
MS • R
Sponsored 8/29/2025
Rep. Stefanik, Elise M. [R-NY-21]
NY • R
Sponsored 8/29/2025
Rep. Gonzalez, Vicente [D-TX-34]
TX • D
Sponsored 9/4/2025
Rep. Norcross, Donald [D-NJ-1]
NJ • D
Sponsored 9/9/2025
Lee (NV)
NV • D
Sponsored 9/23/2025
Rep. Pappas, Chris [D-NH-1]
NH • D
Sponsored 9/30/2025
Rep. Fields, Cleo [D-LA-6]
LA • D
Sponsored 10/3/2025
Rep. Murphy, Gregory F. [R-NC-3]
NC • R
Sponsored 10/3/2025
Rep. Titus, Dina [D-NV-1]
NV • D
Sponsored 10/3/2025
Mannion
NY • D
Sponsored 10/3/2025
Schmidt
KS • R
Sponsored 10/3/2025
Rep. Ezell, Mike [R-MS-4]
MS • R
Sponsored 10/3/2025
Rep. Wilson, Joe [R-SC-2]
SC • R
Sponsored 10/8/2025
Rep. Tlaib, Rashida [D-MI-12]
MI • D
Sponsored 10/8/2025
Rep. Owens, Burgess [R-UT-4]
UT • R
Sponsored 10/8/2025
Mann
KS • R
Sponsored 10/8/2025
Rep. Vindman, Eugene Simon [D-VA-7]
VA • D
Sponsored 10/8/2025
McBride
DE • D
Sponsored 10/10/2025
Rep. Baumgartner, Michael [R-WA-5]
WA • R
Sponsored 10/10/2025
Rep. Beatty, Joyce [D-OH-3]
OH • D
Sponsored 10/14/2025
Rep. Barrett, Tom [R-MI-7]
MI • R
Sponsored 10/17/2025
Rep. Mullin, Kevin [D-CA-15]
CA • D
Sponsored 10/17/2025
Rep. Davis, Danny K. [D-IL-7]
IL • D
Sponsored 10/21/2025
Bergman
MI • R
Sponsored 10/21/2025
Rep. Swalwell, Eric [D-CA-14]
CA • D
Sponsored 10/21/2025
Rep. Panetta, Jimmy [D-CA-19]
CA • D
Sponsored 10/28/2025
Rep. Neguse, Joe [D-CO-2]
CO • D
Sponsored 10/28/2025
Rep. Vasquez, Gabe [D-NM-2]
NM • D
Sponsored 11/4/2025
Rep. Pingree, Chellie [D-ME-1]
ME • D
Sponsored 11/4/2025
Rep. Hoyle, Val T. [D-OR-4]
OR • D
Sponsored 11/7/2025
Rep. Mackenzie, Ryan [R-PA-7]
PA • R
Sponsored 11/12/2025
Craig
MN • D
Sponsored 11/17/2025
Goldman (TX)
TX • R
Sponsored 11/20/2025
Rep. Williams, Roger [R-TX-25]
TX • R
Sponsored 12/1/2025
Norman
SC • R
Sponsored 12/2/2025
Miller (IL)
IL • R
Sponsored 12/3/2025
Rep. Simon, Lateefah [D-CA-12]
CA • D
Sponsored 12/5/2025
Ansari
AZ • D
Sponsored 12/11/2025
Bynum
OR • D
Sponsored 12/12/2025
Gillen
NY • D
Sponsored 12/15/2025
Rescom. Hernández, Pablo Jose [D-PR-At Large]
PR • D
Sponsored 12/17/2025
Evans (CO)
CO • R
Sponsored 12/17/2025
Rep. Fry, Russell [R-SC-7]
SC • R
Sponsored 12/18/2025
Randall
WA • D
Sponsored 1/12/2026
Rep. Ross, Deborah K. [D-NC-2]
NC • D
Sponsored 1/14/2026
Westerman
AR • R
Sponsored 1/21/2026
Moore (WV)
WV • R
Sponsored 2/3/2026
Langworthy
NY • R
Sponsored 2/5/2026
Rep. McDonald Rivet, Kristen [D-MI-8]
MI • D
Sponsored 2/10/2026
Rep. Walkinshaw, James R. [D-VA-11]
VA • D
Sponsored 3/12/2026
Rep. DelBene, Suzan K. [D-WA-1]
WA • D
Sponsored 3/17/2026
Rep. Amo, Gabe [D-RI-1]
RI • D
Sponsored 3/18/2026
Rep. Stansbury, Melanie Ann [D-NM-1]
NM • D
Sponsored 3/19/2026
Biggs (SC)
SC • R
Sponsored 3/24/2026
Whitesides
CA • D
Sponsored 3/25/2026
Rep. Lofgren, Zoe [D-CA-18]
CA • D
Sponsored 3/25/2026
Rep. Gooden, Lance [R-TX-5]
TX • R
Sponsored 4/6/2026
Rep. Larsen, Rick [D-WA-2]
WA • D
Sponsored 4/6/2026
Rep. Kiggans, Jennifer A. [R-VA-2]
VA • R
Sponsored 4/6/2026
Rep. Van Orden, Derrick [R-WI-3]
WI • R
Sponsored 4/21/2026
Tiffany
WI • R
Sponsored 4/9/2026
McGuire
VA • R
Sponsored 4/15/2026
Kelly (PA)
PA • R
Sponsored 4/15/2026
Hageman
WY • R
Sponsored 4/13/2026
Rep. Garcia, Sylvia R. [D-TX-29]
TX • D
Sponsored 4/16/2026
Rep. Scholten, Hillary J. [D-MI-3]
MI • D
Sponsored 4/16/2026
Rep. Guest, Michael [R-MS-3]
MS • R
Sponsored 4/27/2026
Van Epps
TN • R
Sponsored 5/4/2026
Roll Call Votes
No roll call votes available for this bill.
View on Congress.govTake It Personal
Get Your Personalized Policy View
Take the PRIA Score to see how policy affects your household, then upgrade to PRIA Full Coverage for year-round monitoring.
Already have an account? Sign in