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A BILL TO BE ENTITLED
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AN ACT
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relating to direct payment by a health or automobile insurer of |
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physicians and health care providers. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. The heading of Subchapter B, Chapter 1204, |
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Insurance Code, is amended to read as follows: |
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SUBCHAPTER B. ASSIGNMENT OF BENEFIT PAYMENTS; DIRECT PAYMENT OF |
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BENEFITS |
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SECTION 2. Subchapter B, Chapter 1204, Insurance Code, is |
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amended by adding Sections 1204.056, 1204.057, and 1204.058 to read |
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as follows: |
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Sec. 1204.056. ASSIGNMENT OF BENEFITS OPTION REQUIRED. |
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(a) A health insurance policy claim form must provide an option |
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for the claimant to assign benefits to a physician or health care |
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provider who provided covered services. For purposes of this |
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subchapter, "health care provider" includes a licensed provider of |
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ambulance services. |
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(b) The health insurer may require a written attestation of |
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assignment of benefits. |
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Sec. 1204.057. AMOUNT OF PAYMENT UNDER ASSIGNMENT OF |
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BENEFITS. A payment to a physician or health care provider under an |
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assignment of benefits may not be more than the amount the insurer |
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would have paid in the absence of an assignment of benefits. |
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Sec. 1204.058. DIRECT PAYMENT PROVISION AUTHORIZED. A |
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health insurance policy may provide for payment of benefits |
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directly to a physician or health care provider who provides |
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covered services to a covered person, even in the absence of an |
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assignment of benefits. |
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SECTION 3. Subchapter B, Chapter 1301, Insurance Code, is |
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amended by adding Section 1301.0561 to read as follows: |
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Sec. 1301.0561. DIRECT PAYMENT OF PREFERRED PROVIDERS |
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REQUIRED. An insurer that issues a preferred provider benefit plan |
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shall pay a preferred provider directly for covered services |
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provided to a person insured under the plan, in accordance with this |
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chapter, without requiring an assignment of benefits. |
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SECTION 4. Subtitle C, Title 10, Insurance Code, is amended |
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by adding Chapter 1955 to read as follows: |
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CHAPTER 1955. PAYMENT OF CERTAIN BENEFITS UNDER AUTOMOBILE |
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INSURANCE POLICY |
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Sec. 1955.001. APPLICABILITY OF CHAPTER. This chapter |
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applies to an insurer writing automobile insurance in this state, |
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including an insurance company, corporation, reciprocal or |
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interinsurance exchange, mutual insurance company, association, |
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Lloyd's plan, or other insurer. |
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Sec. 1955.002. ASSIGNMENT OF BENEFITS OPTION REQUIRED. An |
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automobile insurance policy claim form must provide an option for |
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the claimant to assign benefits to an ambulance service provider |
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who provides services covered under the policy in connection with |
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an occurrence covered by the policy. The automobile insurer may |
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require a written attestation of assignment of benefits. |
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Sec. 1955.003. DIRECT PAYMENT PROVISION AUTHORIZED. An |
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automobile insurance policy may provide for payment of benefits |
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directly to an ambulance service provider who provides services |
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covered under the policy in connection with an occurrence covered |
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by the policy, even in the absence of an assignment of benefits. |
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SECTION 5. The changes in law made by this Act apply only to |
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an insurance policy delivered, issued for delivery, or renewed on |
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or after January 1, 2010. An insurance policy delivered, issued for |
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delivery, or renewed before January 1, 2010, is governed by the law |
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in effect immediately before the effective date of this Act, and |
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that law is continued in effect for that purpose. |
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SECTION 6. This Act takes effect September 1, 2009. |