GroundRules
← Search the law
Texas · Through 89th 2nd Called Legislative Session, 2025

Tex. Insurance Code § 1301.140: OUT-OF-POCKET EXPENSE CREDIT.

Read at publisher ↗
Where this section sits in the code
  1. INSURANCE CODE
  2. TITLE 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES
  3. SUBTITLE D. PROVIDER PLANS
  4. CHAPTER 1301. PREFERRED PROVIDER BENEFIT PLANS
  5. SUBCHAPTER C-1. OTHER PROVISIONS RELATING TO PAYMENT OF CLAIMS

(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 medically necessary 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.

Added by Acts 2023, 88th Leg., R.S., Ch. 437 (H.B. 2002), Sec. 1, eff. September 1, 2023.

Collected 2026-08-27T01:47:21Z. Source file · JSON

Browse this collection