TITLE: Relating to preferred provider benefit plan out-of-pocket expense credits for payments made by an insured directly to a physician providing direct primary care.

SUMMARY: Relating to preferred provider benefit plan out-of-pocket expense credits for payments made by an insured directly to a physician providing direct primary care.

FULL TEXT:
AN ACT relating to preferred provider benefit plan out-of-pocket expense credits for payments made by an insured directly to a physician providing direct primary care. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: SECTION 1. Section 1301.140, Insurance Code, is amended by adding Subsection (a-1) to read as follows: (a-1) For purposes of Subsection (a), an insurer who provides coverage for primary care services shall treat a direct fee charged by a physician who provides direct primary care as a fee for a medically necessary covered medical or health care service or supply. In this subsection, "direct fee" and "direct primary care" have the meanings assigned by Section 162.251, Occupations Code. SECTION 2. Section 1301.140(a-1), 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, 2026. SECTION 3. This Act takes effect September 1, 2025.