88R24284 CJD-D
 
  By: Oliverson, Price H.B. No. 2002
 
  Substitute the following for H.B. No. 2002:
 
  By:  Harless C.S.H.B. No. 2002
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to preferred provider benefit plan out-of-pocket expense
  credits for payments made by an insured directly to a physician or
  health care provider.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subchapter C-1, Chapter 1301, Insurance Code, is
  amended by adding Section 1301.140 to read as follows:
         Sec. 1301.140.  OUT-OF-POCKET EXPENSE CREDIT. (a) An
  insurer shall credit toward an insured's deductible and annual
  maximum out-of-pocket expenses an amount the insured pays directly
  to any physician or health care provider for a medically necessary
  covered medical or health care service or supply if a claim for the
  service or supply is not submitted to the insurer and the amount
  paid by the insured to the physician or health care provider is less
  than the average discounted rate for the service or supply paid to
  an equivalently licensed or authorized preferred provider under the
  insured's preferred provider benefit plan.
         (b)  An insurer shall:
               (1)  establish a procedure by which an insured may
  claim a credit under Subsection (a); and
               (2)  identify documentation necessary to support a
  claim for a credit under Subsection (a).
         (c)  Information about the procedure and documentation
  described by Subsection (b) must be readily accessible to an
  insured on the insurer's Internet website.
         SECTION 2.  Section 1301.140, Insurance Code, as added by
  this Act, applies only to a preferred provider benefit plan that is
  delivered, issued for delivery, or renewed on or after January 1,
  2024.
         SECTION 3.  This Act takes effect September 1, 2023.