88R24330 CJD-D
By: Harris of Williamson H.B. No. 4500
Substitute the following for H.B. No. 4500:
By: Oliverson C.S.H.B. No. 4500
A BILL TO BE ENTITLED
AN ACT
relating to electronic verification of health benefits by health
benefit plan issuers for certain physicians and health care
providers.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle A, Title 8, Insurance Code, is amended
by adding Chapter 1223 to read as follows:
CHAPTER 1223. VERIFICATION OF HEALTH BENEFITS
Sec. 1223.001. APPLICABILITY OF CHAPTER. (a) This chapter
applies only to a health benefit plan that provides benefits for
medical or surgical expenses incurred as a result of a health
condition, accident, or sickness, including an individual, group,
blanket, or franchise insurance policy or insurance agreement, a
group hospital service contract, or an individual or group evidence
of coverage or similar coverage document that is issued by:
(1) an insurance company;
(2) a group hospital service corporation operating
under Chapter 842;
(3) a health maintenance organization operating under
Chapter 843;
(4) an approved nonprofit health corporation that
holds a certificate of authority under Chapter 844;
(5) a multiple employer welfare arrangement that holds
a certificate of authority under Chapter 846;
(6) a stipulated premium company operating under
Chapter 884;
(7) a Lloyd's plan operating under Chapter 941; or
(8) an exchange operating under Chapter 942.
(b) Notwithstanding any other law, this chapter applies to:
(1) a small employer health benefit plan subject to
Chapter 1501, including coverage provided through a health group
cooperative under Subchapter B of that chapter;
(2) a standard health benefit plan issued under
Chapter 1507;
(3) a basic coverage plan under Chapter 1551;
(4) a basic plan under Chapter 1575;
(5) a primary care coverage plan under Chapter 1579;
(6) a plan providing basic coverage under Chapter
1601;
(7) nonprofit agricultural organization health
benefits offered by a nonprofit agricultural organization under
Chapter 1682;
(8) alternative health benefit coverage offered by a
subsidiary of the Texas Mutual Insurance Company under Subchapter
M, Chapter 2054;
(9) group health coverage made available by a school
district in accordance with Section 22.004, Education Code;
(10) a regional or local health care program operated
under Section 75.104, Health and Safety Code; and
(11) a self-funded health benefit plan sponsored by a
professional employer organization under Chapter 91, Labor Code.
(c) This chapter does not apply to the state Medicaid
program, including the Medicaid managed care program operated under
Chapter 533, Government Code, or the child health plan program
operated under Chapter 62, Health and Safety Code.
Sec. 1223.002. INTERNET WEBSITE FOR VERIFICATION REQUIRED
FOR EMERGENCY PHYSICIANS AND HEALTH CARE PROVIDERS. (a) A health
benefit plan issuer shall maintain and make available a secure
system on the issuer's Internet website that allows a physician or
health care provider for a hospital or freestanding emergency
medical care facility to determine at any time:
(1) whether the physician's or provider's patient is
covered by the issuer's health benefit plan; and
(2) the deductible, copayment, or coinsurance for
which the patient is responsible.
(b) A health benefit plan issuer may provide the information
described by Subsection (a) through:
(1) an existing Internet portal that is available at
all times; or
(2) an Internet portal that is:
(A) provided by a third party contracting with
the issuer; and
(B) available at all times.
SECTION 2. This Act takes effect January 1, 2024.