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A BILL TO BE ENTITLED
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AN ACT
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relating to out-of-pocket expense credits for payments made by a |
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policyholder directly to a physician or health care provider. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter C-1, Chapter 1301, Insurance Code, is |
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amended by adding Section 1301.140 to read as follows: |
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Sec. 1301.140. OUT-OF-POCKET EXPENSE CREDIT. (a) An |
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insurer shall credit toward an insured's deductible and annual |
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maximum out-of-pocket expenses an amount the insured pays directly |
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to any physician or health care provider for a covered medical or |
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health care service if a claim for the service is not submitted to |
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the insurer and the amount paid by the insured to the physician or |
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health care provider is less than the average discounted rate for |
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the service paid to an equivalently licensed or authorized |
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preferred provider under the insured's preferred provider benefit |
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plan. |
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(b) An insurer shall: |
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(1) establish a procedure by which an insured may |
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claim a credit under Subsection (a); and |
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(2) identify documentation necessary to support a |
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claim for a credit under Subsection (a). |
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(c) Information about the procedure and documentation |
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described by Subsection (b) must be readily accessible to an |
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insured on the insurer's Internet website. |
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SECTION 2. Section 1301.140, Insurance Code, as added by |
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this Act, applies only to a health benefit plan that is delivered, |
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issued for delivery, or renewed on or after January 1, 2018. A |
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health benefit plan delivered, issued for delivery, or renewed |
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before January 1, 2018, is governed by the law as it existed |
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immediately before the effective date of this Act, and that law is |
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continued in effect for that purpose. |
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SECTION 3. This Act takes effect September 1, 2017. |