| 1 | 1 | | H.B. No. 2002 |
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| 2 | 2 | | |
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| 3 | 3 | | |
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| 4 | 4 | | AN ACT |
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| 5 | 5 | | relating to preferred provider benefit plan out-of-pocket expense |
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| 6 | 6 | | credits for payments made by an insured directly to a physician or |
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| 7 | 7 | | health care provider. |
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| 8 | 8 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 9 | 9 | | SECTION 1. Subchapter C-1, Chapter 1301, Insurance Code, is |
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| 10 | 10 | | amended by adding Section 1301.140 to read as follows: |
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| 11 | 11 | | Sec. 1301.140. OUT-OF-POCKET EXPENSE CREDIT. (a) An |
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| 12 | 12 | | insurer shall credit toward an insured's deductible and annual |
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| 13 | 13 | | maximum out-of-pocket expenses an amount the insured pays directly |
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| 14 | 14 | | to any physician or health care provider for a medically necessary |
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| 15 | 15 | | covered medical or health care service or supply if a claim for the |
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| 16 | 16 | | service or supply is not submitted to the insurer and the amount |
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| 17 | 17 | | paid by the insured to the physician or health care provider is less |
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| 18 | 18 | | than the average discounted rate for the service or supply paid to |
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| 19 | 19 | | an equivalently licensed or authorized preferred provider under the |
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| 20 | 20 | | insured's preferred provider benefit plan. |
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| 21 | 21 | | (b) An insurer shall: |
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| 22 | 22 | | (1) establish a procedure by which an insured may |
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| 23 | 23 | | claim a credit under Subsection (a); and |
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| 24 | 24 | | (2) identify documentation necessary to support a |
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| 25 | 25 | | claim for a credit under Subsection (a). |
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| 26 | 26 | | (c) Information about the procedure and documentation |
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| 27 | 27 | | described by Subsection (b) must be readily accessible to an |
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| 28 | 28 | | insured on the insurer's Internet website. |
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| 29 | 29 | | SECTION 2. Section 1301.140, Insurance Code, as added by |
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| 30 | 30 | | this Act, applies only to a preferred provider benefit plan that is |
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| 31 | 31 | | delivered, issued for delivery, or renewed on or after January 1, |
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| 32 | 32 | | 2024. |
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| 33 | 33 | | SECTION 3. This Act takes effect September 1, 2023. |
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| 34 | 34 | | ______________________________ ______________________________ |
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| 35 | 35 | | President of the Senate Speaker of the House |
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| 36 | 36 | | I certify that H.B. No. 2002 was passed by the House on May 4, |
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| 37 | 37 | | 2023, by the following vote: Yeas 144, Nays 0, 2 present, not |
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| 38 | 38 | | voting. |
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| 39 | 39 | | ______________________________ |
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| 40 | 40 | | Chief Clerk of the House |
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| 41 | 41 | | I certify that H.B. No. 2002 was passed by the Senate on May |
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| 42 | 42 | | 19, 2023, by the following vote: Yeas 31, Nays 0. |
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| 43 | 43 | | ______________________________ |
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| 44 | 44 | | Secretary of the Senate |
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| 45 | 45 | | APPROVED: _____________________ |
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| 46 | 46 | | Date |
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| 47 | 47 | | _____________________ |
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| 48 | 48 | | Governor |
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