reglab/housing_qa huggingface dataset:
TX Ins Code § 1662.054 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle J - Health Information Technology and Availability|Chapter 1662 - Health Care Cost Transparency|Subchapter B. Required Disclosures to Enrollees|Section 1662.054. Internet-Based Self-Service Tool

Sec. 1662.054.  INTERNET-BASED SELF-SERVICE TOOL. (a) A health benefit plan issuer or administrator may develop and maintain an Internet-based self-service tool to provide a disclosure required under this subchapter.(b)  Information provided on the self-service tool must be made available in plain language, without a subscription or other fee, on an Internet website that provides real-time responses based on cost-sharing information that is accurate at the time of the request.(c)  A health benefit plan issuer or administrator shall ensure that the self-service tool allows a user to:(1)  search for cost-sharing information for a covered health care service or supply by a specific network provider or by all network providers by inputting:(A)  a billing code or descriptive term at the option of the user;(B)  the name of the network provider if the user seeks cost-sharing information with respect to a specific network provider; or(C)  other factors used by the issuer or administrator that are relevant for determining the applicable cost-sharing information, including the location in which the service or supply will be sought or provided, the facility name, or the dosage;(2)  search for an out-of-network allowed amount, percentage of billed charges, or other rate that provides a reasonably accurate estimate of the amount the issuer or administrator will pay for a covered health care service or supply provided by an out-of-network provider by inputting:(A)  a billing code or descriptive term at the option of the user; or(B)  other factors used by the issuer or administrator that are relevant for determining the applicable out-of-network allowed amount or other rate, including the location in which the covered health care service or supply will be sought or provided; and(3)  refine and reorder search results based on geographic proximity of network providers and the amount of the enrollee's estimated cost-sharing liability for the covered health care service or supply if the search returns multiple results.|Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090), Sec. 3, eff. September 1, 2021.|
TX Ins Code § 1662.055 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle J - Health Information Technology and Availability|Chapter 1662 - Health Care Cost Transparency|Subchapter B. Required Disclosures to Enrollees|Section 1662.055. Physical Copy of Disclosure

Sec. 1662.055.  PHYSICAL COPY OF DISCLOSURE.  (a) A health benefit plan issuer or administrator shall make the disclosure required under this subchapter available in a physical form.  A disclosure under this section must be made available in plain language, without a fee, at the request of the enrollee.(b)  In providing a disclosure under this section, a health benefit plan issuer or administrator may limit the number of health care providers with respect to which cost-sharing information for a covered health care service or supply is provided to no fewer than 20 providers per request.(c)  A health benefit plan issuer or administrator providing a disclosure under this section shall:(1)  disclose any applicable provider-per-request limit described by Subsection (b) to the enrollee;(2)  provide the cost-sharing information in a physical form in accordance with the enrollee's request as if the request was made using a self-service tool under Section 1662.054; and(3)  mail the disclosure not later than two business days after the date the enrollee's request is received.|Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090), Sec. 3, eff. September 1, 2021.|
TX Ins Code § 1662.056 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle J - Health Information Technology and Availability|Chapter 1662 - Health Care Cost Transparency|Subchapter B. Required Disclosures to Enrollees|Section 1662.056. Other Means of Disclosure

Sec. 1662.056.  OTHER MEANS OF DISCLOSURE.  If an enrollee requests the disclosure required by this subchapter by a means other than a physical copy or the self-service tool described by Section 1662.054, a health benefit plan issuer or administrator may provide the disclosure through the requested means if:(1)  the enrollee agrees that disclosure through that means is sufficient to satisfy the request;(2)  the request is fulfilled at least as rapidly as required for the physical copy; and(3)  the disclosure includes the information required for a physical copy under Section 1662.055.|Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090), Sec. 3, eff. September 1, 2021.|
TX Ins Code § 1662.057 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle J - Health Information Technology and Availability|Chapter 1662 - Health Care Cost Transparency|Subchapter B. Required Disclosures to Enrollees|Section 1662.057. Other Contractual Agreements

Sec. 1662.057.  OTHER CONTRACTUAL AGREEMENTS.  (a) A health benefit plan issuer or administrator may satisfy the requirements of this subchapter by entering into a written agreement under which another person, including a pharmacy benefit manager or other third party, provides the disclosure required under this subchapter.(b)  If a health benefit plan issuer or administrator and another person enter into an agreement under Subsection (a), the issuer or administrator is subject to an enforcement action for failure to provide a required disclosure in accordance with this subchapter.|Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090), Sec. 3, eff. September 1, 2021.|
TX Ins Code § 1662.058 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle J - Health Information Technology and Availability|Chapter 1662 - Health Care Cost Transparency|Subchapter B. Required Disclosures to Enrollees|Section 1662.058. Compliance With Subchapter

Sec. 1662.058.  COMPLIANCE WITH SUBCHAPTER.  (a) A health benefit plan issuer or administrator that, acting in good faith and with reasonable diligence, makes an error or omission in a disclosure required under this subchapter does not fail to comply with this subchapter solely because of the error or omission if the issuer or administrator corrects the error or omission as soon as practicable.(b)  A health benefit plan issuer or administrator, acting in good faith and with reasonable diligence, does not fail to comply with this subchapter solely because the issuer's or administrator's Internet website is temporarily inaccessible if the issuer or administrator makes the information available as soon as practicable.(c)  To the extent compliance with this subchapter requires a health benefit plan issuer or administrator to obtain information from another person, the issuer or administrator does not fail to comply with the subchapter because the issuer or administrator relies in good faith on information from the other person unless the issuer or administrator knows or reasonably should have known that the information is incomplete or inaccurate.|Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090), Sec. 3, eff. September 1, 2021.|
TX Ins Code § 1662.101 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle J - Health Information Technology and Availability|Chapter 1662 - Health Care Cost Transparency|Subchapter C. Required Public Disclosures|Section 1662.101. Applicability of Subchapter

Sec. 1662.101.  APPLICABILITY OF SUBCHAPTER.  This subchapter applies only to a health benefit plan for which federal reporting requirements under 26 C.F.R. Part 54, 29 C.F.R. Part 2590, and 45 C.F.R. Parts 147 and 158 do not apply.|Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090), Sec. 3, eff. September 1, 2021.|
TX Ins Code § 1662.102 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle J - Health Information Technology and Availability|Chapter 1662 - Health Care Cost Transparency|Subchapter C. Required Public Disclosures|Section 1662.102. Publication Required

Sec. 1662.102.  PUBLICATION REQUIRED.  A health benefit plan issuer or administrator shall publish on an Internet website the information required under Section 1662.103 in three machine-readable files in accordance with this subchapter.|Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090), Sec. 3, eff. September 1, 2021.|
TX Ins Code § 1662.104 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle J - Health Information Technology and Availability|Chapter 1662 - Health Care Cost Transparency|Subchapter C. Required Public Disclosures|Section 1662.104. Network Rate Disclosures

Sec. 1662.104.  NETWORK RATE DISCLOSURES.  (a) If a health benefit plan issuer or administrator does not use negotiated rates for health care provider reimbursement, the issuer or administrator shall disclose for purposes of Section 1662.103(a)(1)(C) derived amounts to the extent those amounts are already calculated in the normal course of business.(b)  If a health benefit plan issuer or administrator uses underlying fee schedule rates for calculating cost sharing, the issuer or administrator shall disclose for purposes of Section 1662.103(a)(1)(C) the underlying fee schedule rates in addition to the negotiated rate or derived amount.(c)  The applicable rates, including for both individual health care services and supplies and services and supplies in a bundled payment arrangement, that a health benefit plan issuer or administrator must provide under Section 1662.103(a)(1)(C) must be:(1)  except as provided by Subdivision (2), reflected as dollar amounts with respect to each covered health care service or supply that is provided by a network provider;(2)  the base negotiated rate applicable to the service or supply before an adjustment for enrollee characteristics if the rate is a negotiated rate subject to change based on enrollee characteristics;(3)  associated with the national provider identifier, tax identification number, and place of service code for each network provider;(4)  associated with the last date of the contract term or expiration date for each health care provider-specific applicable rate that applies to each covered service or supply; and(5)  indicated with a notation where a reimbursement arrangement other than a standard fee-for-service model, including capitation or a bundled payment arrangement, applies.|Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090), Sec. 3, eff. September 1, 2021.|
TX Ins Code § 1662.105 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle J - Health Information Technology and Availability|Chapter 1662 - Health Care Cost Transparency|Subchapter C. Required Public Disclosures|Section 1662.105. Out-of-Network Allowed Amounts

Sec. 1662.105.  OUT-OF-NETWORK ALLOWED AMOUNTS. (a) An out-of-network allowed amount provided under Section 1662.103(a)(2)(C) must be:(1)  reflected as a dollar amount with respect to each covered health care service or supply that is provided by an out-of-network provider; and(2)  associated with the national provider identifier, tax identification number, and place of service code for each out-of-network provider.(b)  This subchapter does not prohibit a health benefit plan issuer or administrator from satisfying the disclosure requirements described by Section 1662.103(a)(2)(C) by disclosing out-of-network allowed amounts made available by, or otherwise obtained from, an issuer, a health care provider, or other party with which the issuer or administrator has entered into a written agreement to provide the information if the minimum claim threshold described by Section 1662.103(b) is independently met for each health care service or supply and for each plan included in an aggregated allowed amount file.(c)  If a health benefit plan issuer or administrator enters into an agreement under Subsection (b), the health benefit plan issuers, health care providers, or other persons with which the issuer or administrator has contracted may aggregate out-of-network allowed amounts for more than one plan.(d)  This subchapter does not prohibit a third party from hosting an allowed amount file on its Internet website or a health benefit plan issuer or administrator from contracting with a third party to post the file. If the issuer or administrator does not host the file separately on its Internet website, the issuer or administrator shall provide a link on its Internet website to the location where the file is made publicly available.|Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090), Sec. 3, eff. September 1, 2021.|
TX Ins Code § 1662.106 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle J - Health Information Technology and Availability|Chapter 1662 - Health Care Cost Transparency|Subchapter C. Required Public Disclosures|Section 1662.106. Historical Net Price

Sec. 1662.106.  HISTORICAL NET PRICE.  (a) For purposes of determining the historical net price for a prescription drug, the allocation of price concessions is determined by the dollar value for non-product specific and product-specific rebates, discounts, chargebacks, fees, and other price concessions to the extent that the total amount of any such price concession is known to the health benefit plan issuer or administrator at the time of publication of the historical net price under Section 1662.103(a)(3)(D).(b)  To the extent that the total amount of any non-product specific and product-specific rebates, discounts, chargebacks, fees, or other price concessions is not known to a health benefit plan issuer or administrator at the time of publication of the historical net price under Section 1662.103(a)(3)(D), the issuer or administrator shall allocate those price concessions by using a good faith, reasonable estimate of the average price concessions based on the price concessions received over a period before the current reporting period and of equal duration to the current reporting period.|Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090), Sec. 3, eff. September 1, 2021.|
TX Ins Code § 1662.107 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle J - Health Information Technology and Availability|Chapter 1662 - Health Care Cost Transparency|Subchapter C. Required Public Disclosures|Section 1662.107. Required Method and Format for Disclosure

Sec. 1662.107.  REQUIRED METHOD AND FORMAT FOR DISCLOSURE.  The machine-readable files described by Section 1662.103 must be available in a form and manner prescribed by department rule. The files must be available and accessible to any person free of charge and without conditions, including establishment of a user account, password, or other credentials, or submission of personally identifiable information to access the file.|Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090), Sec. 3, eff. September 1, 2021.|
TX Ins Code § 1662.108 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle J - Health Information Technology and Availability|Chapter 1662 - Health Care Cost Transparency|Subchapter C. Required Public Disclosures|Section 1662.108. File Updates

Sec. 1662.108.  FILE UPDATES.  A health benefit plan issuer or administrator shall update the machine-readable files described by Section 1662.103 and the information described by this subchapter monthly. The issuer or administrator must clearly indicate in the files the date that the files were most recently updated.|Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090), Sec. 3, eff. September 1, 2021.|
TX Ins Code § 1662.109 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle J - Health Information Technology and Availability|Chapter 1662 - Health Care Cost Transparency|Subchapter C. Required Public Disclosures|Section 1662.109. Other Contractual Agreements

Sec. 1662.109.  OTHER CONTRACTUAL AGREEMENTS.  (a) A health benefit plan issuer or administrator may satisfy the requirements of this subchapter by entering into a written agreement under which another person, including a third-party administrator or health care claims clearinghouse, provides the disclosure required under this subchapter in compliance with this subchapter.(b)  If a health benefit plan issuer or administrator and another person enter into an agreement under Subsection (a), the issuer or administrator is subject to an enforcement action for failure to provide a required disclosure in accordance with this subchapter.|Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090), Sec. 3, eff. September 1, 2021.|
TX Ins Code § 1662.110 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle J - Health Information Technology and Availability|Chapter 1662 - Health Care Cost Transparency|Subchapter C. Required Public Disclosures|Section 1662.110. Compliance With Subchapter

Sec. 1662.110.  COMPLIANCE WITH SUBCHAPTER.  (a) A health benefit plan issuer or administrator that, acting in good faith and with reasonable diligence, makes an error or omission in a disclosure required under this subchapter does not fail to comply with this subchapter solely because of the error or omission if the issuer or administrator corrects the error or omission as soon as practicable.(b)  A health benefit plan issuer or administrator, acting in good faith and with reasonable diligence, does not fail to comply with this subchapter solely because the issuer's or administrator's Internet website is temporarily inaccessible if the issuer or administrator makes the information available as soon as practicable. (c)  To the extent compliance with this subchapter requires a health benefit plan issuer or administrator to obtain information from another person, the issuer or administrator does not fail to comply with the subchapter because the issuer or administrator relies in good faith on information from the other person unless the issuer or administrator knows or reasonably should have known that the information is incomplete or inaccurate.|Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090), Sec. 3, eff. September 1, 2021.|
TX Ins Code § 1698.001 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle N - Rates|Chapter 1698 - Rates for Certain Coverage|Subchapter A. General Provisions|Section 1698.001. Applicability of Chapter

Sec. 1698.001.  APPLICABILITY OF CHAPTER.  This chapter applies only to rates for the following health benefit plans:(1)  an individual major medical expense insurance policy to which Chapter 1201 applies;(2)  individual health maintenance organization coverage; or(3)  a small employer health benefit plan provided under Chapter 1501.|Added by Acts 2021, 87th Leg., R.S., Ch. 877 (S.B. 1296), Sec. 1, eff. September 1, 2021.|
TX Ins Code § 1698.002 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle N - Rates|Chapter 1698 - Rates for Certain Coverage|Subchapter A. General Provisions|Section 1698.002. Applicability of Other Laws Governing Rates

Sec. 1698.002.  APPLICABILITY OF OTHER LAWS GOVERNING RATES.  The requirements of this chapter are in addition to any other provision of this code governing health benefit plan rates.  Except as otherwise provided by this chapter, in the case of a conflict between this chapter and another provision of this code, this chapter controls.|Added by Acts 2021, 87th Leg., R.S., Ch. 877 (S.B. 1296), Sec. 1, eff. September 1, 2021.|
TX Ins Code § 1698.051 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle N - Rates|Chapter 1698 - Rates for Certain Coverage|Subchapter B. Review of Rates|Section 1698.051. Review of Premium Rates

Sec. 1698.051.  REVIEW OF PREMIUM RATES.  (a)  In this section:(1)  "Individual health benefit plan" means:(A)  an individual accident and health insurance policy to which Chapter 1201 applies; or(B)  individual health maintenance organization coverage.(2)  "Small employer health benefit plan" has the meaning assigned by Section 1501.002.(b)  The commissioner by rule shall establish a process under which the commissioner reviews health benefit plan rates and rate changes for compliance with this chapter and other applicable state and federal law, including 42 U.S.C. Sections 300gg, 300gg-94, and 18032(c) and those sections' implementing regulations, including rules establishing geographic rating areas.|Added by Acts 2021, 87th Leg., R.S., Ch. 877 (S.B. 1296), Sec. 1, eff. September 1, 2021.|
TX Ins Code § 1698.052 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle N - Rates|Chapter 1698 - Rates for Certain Coverage|Subchapter B. Review of Rates|Section 1698.052. Additional Rules and Guidance Related to Individual Health Plan Rates

Sec. 1698.052.  ADDITIONAL RULES AND GUIDANCE RELATED TO INDIVIDUAL HEALTH PLAN RATES.  (a)  In this section, "qualified health plan" has the meaning assigned by Section 1301(a), Patient Protection and Affordable Care Act (42 U.S.C. Section 18021).(b)  The commissioner shall adopt rules and provide guidance regarding additional requirements related to individual health benefit plans, including qualified health plans, to address the following factors:(1)  whether the plan issuer has complied with all requirements for pooling risk and participating in risk adjustment programs in effect under state or federal law;(2)  the covered benefits or health benefit plan design or, for a rate change, any changes to the benefits or design;(3)  the allowable variations for case characteristics, risk classifications, and participation in programs promoting wellness; and(4)  any other factor listed in 45 C.F.R. Section 154.301(a)(4) to the extent applicable.(c)  In making a determination under this section regarding a proposed rate for a qualified health plan, the commissioner shall consider, in addition to the factors under Subsection (b), the following factors:(1)  the purchasing power of consumers who are eligible for a premium subsidy under the Patient Protection and Affordable Care Act (Pub. L. No. 111-148);(2)  if the plan is in the silver level, as described by 42 U.S.C. Section 18022(d), whether the rate is appropriate for the plan in relation to the rates charged for qualified health plans offering different levels of coverage, taking into account any funding or lack of funding for cost-sharing reductions and the covered benefits for each level of coverage; and(3)  whether the plan issuer utilized the induced demand factors developed by the Centers for Medicare and Medicaid Services for the risk adjustment program established under 42 U.S.C. Section 18063 for the level of coverage offered by the plan or any state-specific induced demand factors established by department regulations.(d)  The commissioner may consider the following factors:(1)  if the commissioner determines appropriate for comparison purposes, medical claims trends reported by plan issuers in this state or in a region of this country or the country as a whole; and(2)  inflation indexes.|Added by Acts 2021, 87th Leg., R.S., Ch. 877 (S.B. 1296), Sec. 1, eff. September 1, 2021.|