Tex. INS Code ch. 1223 — VERIFICATION OF HEALTH BENEFITS | Texas Statutes — Texas

Tex. INS Code § 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) alternative health benefit coverage offered by a subsidiary of the Texas Mutual Insurance Company under Subchapter M , Chapter 2054 ; (8) group health coverage made available by a school district in accordance with Section 22.004 , Education Code; (9) a regional or local health care program operated under Section 75.104 , Health and Safety Code; and (10) 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 540 or 540A , Government Code, or the child health plan program operated under Chapter 62 , Health and Safety Code. Added by Acts 2023, 88th Leg., R.S., Ch. 881 (H.B. 4500 ), Sec. 1, eff. January 1, 2024.

Tex. INS Code § 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. Added by Acts 2023, 88th Leg., R.S., Ch. 881 (H.B. 4500 ), Sec. 1, eff. January 1, 2024.