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A BILL TO BE ENTITLED
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AN ACT
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relating to preferred provider benefit plan out-of-pocket expense |
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credits for payments made by an insured directly to a physician or |
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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 medically necessary |
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covered medical or health care service or supply if a claim for the |
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service or supply is not submitted to the insurer and the amount |
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paid by the insured to the physician or health care provider is less |
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than the average discounted rate for the service or supply paid to |
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an equivalently licensed or authorized preferred provider under the |
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insured's preferred provider benefit 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 preferred provider benefit plan that is |
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delivered, issued for delivery, or renewed on or after January 1, |
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2024. |
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SECTION 3. This Act takes effect September 1, 2023. |