81R9616 AJA-D
By: Seliger S.B. No. 1595
A BILL TO BE ENTITLED
AN ACT
relating to direct payment by a health or automobile insurer of
physicians and health care providers.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. The heading of Subchapter B, Chapter 1204,
Insurance Code, is amended to read as follows:
SUBCHAPTER B. ASSIGNMENT OF BENEFIT PAYMENTS; DIRECT PAYMENT OF
BENEFITS
SECTION 2. Subchapter B, Chapter 1204, Insurance Code, is
amended by adding Sections 1204.056, 1204.057, and 1204.058 to read
as follows:
Sec. 1204.056. ASSIGNMENT OF BENEFITS OPTION REQUIRED.
(a) A health insurance policy claim form must provide an option
for the claimant to assign benefits to a physician or health care
provider who provided covered services. For purposes of this
subchapter, "health care provider" includes a licensed provider of
ambulance services.
(b) The health insurer may require a written attestation of
assignment of benefits.
Sec. 1204.057. AMOUNT OF PAYMENT UNDER ASSIGNMENT OF
BENEFITS. A payment to a physician or health care provider under an
assignment of benefits may not be more than the amount the insurer
would have paid in the absence of an assignment of benefits.
Sec. 1204.058. DIRECT PAYMENT PROVISION AUTHORIZED. A
health insurance policy may provide for payment of benefits
directly to a physician or health care provider who provides
covered services to a covered person, even in the absence of an
assignment of benefits.
SECTION 3. Subchapter B, Chapter 1301, Insurance Code, is
amended by adding Section 1301.0561 to read as follows:
Sec. 1301.0561. DIRECT PAYMENT OF PREFERRED PROVIDERS
REQUIRED. An insurer that issues a preferred provider benefit plan
shall pay a preferred provider directly for covered services
provided to a person insured under the plan, in accordance with this
chapter, without requiring an assignment of benefits.
SECTION 4. Subtitle C, Title 10, Insurance Code, is amended
by adding Chapter 1955 to read as follows:
CHAPTER 1955. PAYMENT OF CERTAIN BENEFITS UNDER AUTOMOBILE
INSURANCE POLICY
Sec. 1955.001. APPLICABILITY OF CHAPTER. This chapter
applies to an insurer writing automobile insurance in this state,
including an insurance company, corporation, reciprocal or
interinsurance exchange, mutual insurance company, association,
Lloyd's plan, or other insurer.
Sec. 1955.002. ASSIGNMENT OF BENEFITS OPTION REQUIRED. An
automobile insurance policy claim form must provide an option for
the claimant to assign benefits to an ambulance service provider
who provides services covered under the policy in connection with
an occurrence covered by the policy. The automobile insurer may
require a written attestation of assignment of benefits.
Sec. 1955.003. DIRECT PAYMENT PROVISION AUTHORIZED. An
automobile insurance policy may provide for payment of benefits
directly to an ambulance service provider who provides services
covered under the policy in connection with an occurrence covered
by the policy, even in the absence of an assignment of benefits.
SECTION 5. The changes in law made by this Act apply only to
an insurance policy delivered, issued for delivery, or renewed on
or after January 1, 2010. An insurance policy delivered, issued for
delivery, or renewed before January 1, 2010, is governed by the law
in effect immediately before the effective date of this Act, and
that law is continued in effect for that purpose.
SECTION 6. This Act takes effect September 1, 2009.