85R13864 PMO-D
By: Oliverson H.B. No. 3546
A BILL TO BE ENTITLED
AN ACT
relating to out-of-pocket expense credits for payments made by a
policyholder 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 covered medical or
health care service if a claim for the service 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 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 health benefit plan that is delivered,
issued for delivery, or renewed on or after January 1, 2018. A
health benefit plan delivered, issued for delivery, or renewed
before January 1, 2018, is governed by the law as it existed
immediately before the effective date of this Act, and that law is
continued in effect for that purpose.
SECTION 3. This Act takes effect September 1, 2017.