88R9407 CJD-D
By: Oliverson 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 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.