| 1 | 1 | | 85R13864 PMO-D |
|---|
| 2 | 2 | | By: Oliverson H.B. No. 3546 |
|---|
| 3 | 3 | | |
|---|
| 4 | 4 | | |
|---|
| 5 | 5 | | A BILL TO BE ENTITLED |
|---|
| 6 | 6 | | AN ACT |
|---|
| 7 | 7 | | relating to out-of-pocket expense credits for payments made by a |
|---|
| 8 | 8 | | policyholder directly to a physician or health care provider. |
|---|
| 9 | 9 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|---|
| 10 | 10 | | SECTION 1. Subchapter C-1, Chapter 1301, Insurance Code, is |
|---|
| 11 | 11 | | amended by adding Section 1301.140 to read as follows: |
|---|
| 12 | 12 | | Sec. 1301.140. OUT-OF-POCKET EXPENSE CREDIT. (a) An |
|---|
| 13 | 13 | | insurer shall credit toward an insured's deductible and annual |
|---|
| 14 | 14 | | maximum out-of-pocket expenses an amount the insured pays directly |
|---|
| 15 | 15 | | to any physician or health care provider for a covered medical or |
|---|
| 16 | 16 | | health care service if a claim for the service is not submitted to |
|---|
| 17 | 17 | | the insurer and the amount paid by the insured to the physician or |
|---|
| 18 | 18 | | health care provider is less than the average discounted rate for |
|---|
| 19 | 19 | | the service paid to an equivalently licensed or authorized |
|---|
| 20 | 20 | | preferred provider under the insured's preferred provider benefit |
|---|
| 21 | 21 | | plan. |
|---|
| 22 | 22 | | (b) An insurer shall: |
|---|
| 23 | 23 | | (1) establish a procedure by which an insured may |
|---|
| 24 | 24 | | claim a credit under Subsection (a); and |
|---|
| 25 | 25 | | (2) identify documentation necessary to support a |
|---|
| 26 | 26 | | claim for a credit under Subsection (a). |
|---|
| 27 | 27 | | (c) Information about the procedure and documentation |
|---|
| 28 | 28 | | described by Subsection (b) must be readily accessible to an |
|---|
| 29 | 29 | | insured on the insurer's Internet website. |
|---|
| 30 | 30 | | SECTION 2. Section 1301.140, Insurance Code, as added by |
|---|
| 31 | 31 | | this Act, applies only to a health benefit plan that is delivered, |
|---|
| 32 | 32 | | issued for delivery, or renewed on or after January 1, 2018. A |
|---|
| 33 | 33 | | health benefit plan delivered, issued for delivery, or renewed |
|---|
| 34 | 34 | | before January 1, 2018, is governed by the law as it existed |
|---|
| 35 | 35 | | immediately before the effective date of this Act, and that law is |
|---|
| 36 | 36 | | continued in effect for that purpose. |
|---|
| 37 | 37 | | SECTION 3. This Act takes effect September 1, 2017. |
|---|