reglab/statecodes huggingface dataset:
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle J - Health Information Technology and Availability › Chapter 1661 - Information Technology › Section 1661.003. Exceptions

Text of section effective until April 01, 2025
Sec. 1661.003.  EXCEPTIONS.  This chapter does not apply to:
(1)  a health benefit plan that provides coverage only:
(A)  for a specified disease or diseases or under a limited benefit policy;
(B)  for accidental death or dismemberment;
(C)  as a supplement to a liability insurance policy; or
(D)  for dental or vision care;
(2)  disability income insurance coverage;
(3)  credit insurance coverage;
(4)  a hospital confinement indemnity policy;
(5)  a Medicare supplemental policy as defined by Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
(6)  a workers' compensation insurance policy;
(7)  medical payment insurance coverage provided under a motor vehicle insurance policy;
(8)  a long-term care insurance policy, including a nursing home fixed indemnity policy, unless the commissioner determines that the policy provides benefits so comprehensive that the policy is a health benefit plan and should not be subject to the exemption provided under this section;
(9)  the child health plan program under Chapter 62, Health and Safety Code, or the health benefits plan for children under Chapter 63, Health and Safety Code; or
(10)  a Medicaid managed care program operated under Chapter 533, Government Code, or a Medicaid program operated under Chapter 32, Human Resources Code.
Added by Acts 2009, 81st Leg., R.S., Ch. 261 (H.B. 1342), Sec. 1, eff. May 30, 2009.
Amended by:
Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 2.138, eff. April 1, 2025.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle J - Health Information Technology and Availability › Chapter 1661 - Information Technology › Section 1661.003. Exceptions

Text of section effective on April 01, 2025
Sec. 1661.003.  EXCEPTIONS.  This chapter does not apply to:
(1)  a health benefit plan that provides coverage only:
(A)  for a specified disease or diseases or under a limited benefit policy;
(B)  for accidental death or dismemberment;
(C)  as a supplement to a liability insurance policy; or
(D)  for dental or vision care;
(2)  disability income insurance coverage;
(3)  credit insurance coverage;
(4)  a hospital confinement indemnity policy;
(5)  a Medicare supplemental policy as defined by Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
(6)  a workers' compensation insurance policy;
(7)  medical payment insurance coverage provided under a motor vehicle insurance policy;
(8)  a long-term care insurance policy, including a nursing home fixed indemnity policy, unless the commissioner determines that the policy provides benefits so comprehensive that the policy is a health benefit plan and should not be subject to the exemption provided under this section;
(9)  the child health plan program under Chapter 62, Health and Safety Code, or the health benefits plan for children under Chapter 63, Health and Safety Code; or
(10)  a Medicaid managed care program operated under Chapter 540 or 540A, Government Code, as applicable, or a Medicaid program operated under Chapter 32, Human Resources Code.
Added by Acts 2009, 81st Leg., R.S., Ch. 261 (H.B. 1342), Sec. 1, eff. May 30, 2009.
Amended by:
Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 2.138, eff. April 1, 2025.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle J - Health Information Technology and Availability › Chapter 1661 - Information Technology › Section 1661.004. Required Use of Technology by Providers

Sec. 1661.004.  REQUIRED USE OF TECHNOLOGY BY PROVIDERS.  A physician, hospital, or other health care provider shall use information technology as required under this chapter beginning not later than September 1, 2013.
Added by Acts 2009, 81st Leg., R.S., Ch. 261 (H.B. 1342), Sec. 1, eff. May 30, 2009.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle J - Health Information Technology and Availability › Chapter 1661 - Information Technology › Section 1661.005. Refund of Overpayment

Sec. 1661.005.  REFUND OF OVERPAYMENT.  A physician, hospital, or other health care provider that receives an overpayment from an enrollee must refund the amount of the overpayment to the enrollee not later than the 30th day after the date the physician, hospital, or health care provider determines that an overpayment has been made. This section does not apply to an overpayment subject to Section 843.350 or 1301.132.
Added by Acts 2009, 81st Leg., R.S., Ch. 261 (H.B. 1342), Sec. 1, eff. May 30, 2009.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle J - Health Information Technology and Availability › Chapter 1661 - Information Technology › Section 1661.0055. Use of Technology: Waiver

Sec. 1661.0055.  USE OF TECHNOLOGY: WAIVER.  (a)  Notwithstanding Section 1661.004, physicians or health care providers with fewer than five full-time-equivalent employees are not required to use information technology as required under this chapter.
(b)  A health benefit plan issuer may not require, through contract or otherwise, physicians or health care providers with fewer than five full-time-equivalent employees to use information technology as required under this chapter.
(c)  A contract between the issuer of a health benefit plan and a physician or health care provider must provide for a waiver of any requirement for the use of information technology as established or required under this chapter.
(d)  The commissioner shall establish the circumstances under which the requirements of this chapter do not apply to a physician or health care provider including:
(1)  undue hardship, including fiscal or operational hardship; or
(2)  any other special circumstance that would justify an exclusion.
(e)  The commissioner shall establish circumstances under which a waiver under Subsection (c) is required, including:
(1)  undue hardship, including fiscal or operational hardship; or
(2)  any other special circumstance that would justify a waiver.
(f)  Any physician or health care provider that is denied a waiver by a health benefit plan issuer may appeal the denial to the commissioner.  The commissioner shall determine whether a waiver must be granted.
(g)  A health benefit plan issuer may not refuse to contract or renew a contract with a physician or health care provider based in whole or in part on the physician or provider requesting or receiving a waiver or appealing a waiver determination. A health benefit plan issuer may not refuse to contract or renew a contract with a physician or health care provider based in whole or in part on the physician or provider meeting the exemptions contained in Subsections (a) and (b).
(h)  A waiver approved under this section expires September 1, 2013.
Added by Acts 2009, 81st Leg., R.S., Ch. 261 (H.B. 1342), Sec. 1, eff. May 30, 2009.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle J - Health Information Technology and Availability › Chapter 1661 - Information Technology › Section 1661.006. Health Benefit Plan Issuer Conduct

Sec. 1661.006.  HEALTH BENEFIT PLAN ISSUER CONDUCT.  A contract between a health benefit plan issuer and a physician, hospital, or other health care provider may not prohibit the physician, hospital, or health care provider from collecting, at the time of care, the estimated amount for which the enrollee may be financially responsible.
Added by Acts 2009, 81st Leg., R.S., Ch. 261 (H.B. 1342), Sec. 1, eff. May 30, 2009.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle J - Health Information Technology and Availability › Chapter 1661 - Information Technology › Section 1661.007. Certain Fees Prohibited

Sec. 1661.007.  CERTAIN FEES PROHIBITED.  A health benefit plan issuer may not directly charge or collect from an enrollee or a physician, or other health care provider, a fee to cover the costs incurred by the health benefit plan issuer in complying with this chapter.
Added by Acts 2009, 81st Leg., R.S., Ch. 261 (H.B. 1342), Sec. 1, eff. May 30, 2009.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle J - Health Information Technology and Availability › Chapter 1661 - Information Technology › Section 1661.009. Rules

Sec. 1661.009.  RULES.  (a)  The commissioner shall adopt rules as necessary to implement this chapter, including rules that ensure that the information technology used by a health benefit plan issuer does not have legal or technical restrictions for encoding, displaying, exchanging, reading, printing, transmitting, or storing information or data in electronic form.
(b)  Rules adopted by the commissioner must be consistent with national standards established by the Workgroup for Electronic Data Interchange or by other similar organizations recognized by the commissioner.
Added by Acts 2009, 81st Leg., R.S., Ch. 261 (H.B. 1342), Sec. 1, eff. May 30, 2009.
2023 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 A. General Provisions › Section 1662.002. Definition of Accumulated Amounts

Sec. 1662.002.  DEFINITION OF ACCUMULATED AMOUNTS.  (a) In this chapter, "accumulated amounts" means:
(1)  the amount of financial responsibility an enrollee has incurred at the time a request for cost-sharing information is made, with respect to a deductible or out-of-pocket limit; and
(2)  to the extent a health benefit plan imposes a cumulative treatment limitation, including a limitation on the number of health care supplies, days, units, visits, or hours covered in a defined period, on a particular covered health care service or supply independent of individual medical necessity determinations, the amount that has accrued toward the limit on the health care service or supply.
(b)  For an individual enrolled in coverage other than self-only coverage, the term includes the financial responsibility the individual has incurred toward meeting the individual's own deductible or out-of-pocket limit and the amount of financial responsibility that all individuals enrolled in the individual's coverage have incurred, in aggregate, toward meeting the plan's other than self-only deductible or out-of-pocket limit, as applicable.
(c)  The term includes any expense that counts toward a deductible or out-of-pocket limit, including a copayment or coinsurance, but excludes any expense that does not count toward a deductible or out-of-pocket limit, including a premium payment, out-of-pocket expense for out-of-network health care services or supplies, or an amount for a health care service or supply not covered by the health benefit plan.
Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090), Sec. 3, eff. September 1, 2021.
2023 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 A. General Provisions › Section 1662.003. Applicability of Chapter

Sec. 1662.003.  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 offered 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 fraternal benefit society operating under Chapter 885;
(8)  a Lloyd's plan operating under Chapter 941; or
(9)  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)  a regional or local health care program operated under Section 75.104, Health and Safety Code; and
(8)  a self-funded health benefit plan sponsored by a professional employer organization under Chapter 91, Labor Code.
(c)  This chapter does not apply to a health reimbursement arrangement or other account-based health benefit plan or a workers' compensation insurance policy.
Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090), Sec. 3, eff. September 1, 2021.
2023 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 A. General Provisions › Section 1662.004. Rules

Sec. 1662.004.  RULES.  The commissioner may adopt rules necessary to implement this chapter.
Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090), Sec. 3, eff. September 1, 2021.
2023 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 1662.051. Required Disclosure to Enrollee on Request

Sec. 1662.051.  REQUIRED DISCLOSURE TO ENROLLEE ON REQUEST.  (a) On request of a health benefit plan enrollee, the health benefit plan issuer or administrator shall provide to the enrollee a disclosure in accordance with this subchapter.
(b)  A health benefit plan issuer or administrator may allow an enrollee to request cost-sharing information for a specific preventive or non-preventive health care service or supply by including terms such as "preventive," "non-preventive," or "diagnostic" when requesting information under Subsection (a).
Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090), Sec. 3, eff. September 1, 2021.
2023 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 1662.053. Method and Format for Disclosure

Sec. 1662.053.  METHOD AND FORMAT FOR DISCLOSURE.  A health benefit plan issuer or administrator shall provide the disclosure required under this subchapter through an Internet-based self-service tool described by Section 1662.054, a physical copy in accordance with Section 1662.055, or another means authorized by Section 1662.056.
Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090), Sec. 3, eff. September 1, 2021.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle K - Certain Benefits and Arrangements That Are Not Insurance › Chapter 1681 - Health Care Sharing Ministries › Section 1681.001. Treatment as Health Care Sharing Ministry

Sec. 1681.001.  TREATMENT AS HEALTH CARE SHARING MINISTRY.  A faith-based, nonprofit organization that is tax-exempt under the Internal Revenue Code of 1986 qualifies for treatment as a health care sharing ministry under this chapter if it:
(1)  limits its participants to individuals of a similar faith;
(2)  acts as a facilitator among participants who have medical bills and matches those participants with other participants with the present ability to assist those with medical bills in accordance with criteria established by the health care sharing ministry;
(3)  provides for the medical bills of a participant through contributions from one participant to another;
(4)  provides amounts that participants may contribute with no assumption of risk or promise to pay among the participants and no assumption of risk or promise to pay by the health care sharing ministry to the participants;
(5)  provides a written monthly statement to all participants that lists the total dollar amount of qualified needs submitted to the health care sharing ministry, as well as the amount actually published or assigned to participants for their contribution;
(6)  discloses administrative fees and costs to participants;
(7)  provides that any card issued to a participant for the purpose of presentation to a health care provider clearly indicates that the participant is part of a health care sharing ministry that is not engaging in the business of insurance;
(8)  provides a written disclaimer on or accompanying all applications and guideline materials distributed by or on behalf of the ministry that complies with Section 1681.002; and
(9)  does not operate a discount health care program as defined by Section 7001.001.
Added by Acts 2013, 83rd Leg., R.S., Ch. 455 (S.B. 874), Sec. 1, eff. June 14, 2013.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle K - Certain Benefits and Arrangements That Are Not Insurance › Chapter 1681 - Health Care Sharing Ministries › Section 1681.002. Notice

Sec. 1681.002.  NOTICE.  To qualify as a health care sharing ministry under this chapter, the notice described by Section 1681.001(8) must read substantially as follows:
"Notice:  This health care sharing ministry facilitates the sharing of medical expenses and is not an insurance company, and neither its guidelines nor its plan of operation is an insurance policy.  Whether anyone chooses to assist you with your medical bills will be totally voluntary because no other participant will be compelled by law to contribute toward your medical bills.  As such, participation in the ministry or a subscription to any of its documents should never be considered to be insurance.  Regardless of whether you receive any payment for medical expenses or whether this ministry continues to operate, you are always personally responsible for the payment of your own medical bills.  Complaints concerning this health care sharing ministry may be reported to the office of the Texas attorney general."
Added by Acts 2013, 83rd Leg., R.S., Ch. 455 (S.B. 874), Sec. 1, eff. June 14, 2013.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle K - Certain Benefits and Arrangements That Are Not Insurance › Chapter 1681 - Health Care Sharing Ministries › Section 1681.003. Exemption

Sec. 1681.003.  EXEMPTION.  Notwithstanding any other provision of this code, a health care sharing ministry that acts in accordance with this chapter is not considered to be engaging in the business of insurance.
Added by Acts 2013, 83rd Leg., R.S., Ch. 455 (S.B. 874), Sec. 1, eff. June 14, 2013.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle K - Certain Benefits and Arrangements That Are Not Insurance › Chapter 1682 - Health Benefits Provided by Certain Nonprofit Agricultural Organizations › Section 1682.001. Definitions

Sec. 1682.001.  DEFINITIONS.  In this chapter:
(1)  "Nonprofit agricultural organization" means an organization that:
(A)  is exempt from taxation under Section 501(a), Internal Revenue Code of 1986, as an organization described by Section 501(c)(5) of that code;
(B)  is domiciled in this state;
(C)  was in existence prior to 1940;
(D)  is composed of members who are residents of at least 98 percent of the counties in this state;
(E)  collects annual dues from its members; and
(F)  was created to promote and develop the most profitable and desirable system of agriculture and the most wholesome and satisfactory conditions of rural life in accordance with its articles of organization and bylaws.
(2)  "Nonprofit agricultural organization health benefits" means health benefits:
(A)  sponsored by a nonprofit agricultural organization or an affiliate of the organization;
(B)  offered only to:
(i)  members of the nonprofit agricultural organization; and
(ii)  family members of members of the nonprofit agricultural organization;
(C)  that are not provided through an insurance policy or other product the offering or issuance of which is regulated as the business of insurance in this state; and
(D)  that are deemed by the nonprofit agricultural organization to be important in assisting its members to live long and productive lives.
(3)  "Preexisting condition" means a condition present before the effective date of an individual's enrollment in  nonprofit agricultural organization health benefits.
Added by Acts 2021, 87th Leg., R.S., Ch. 1034 (H.B. 3924), Sec. 3, eff. September 1, 2021.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle K - Certain Benefits and Arrangements That Are Not Insurance › Chapter 1682 - Health Benefits Provided by Certain Nonprofit Agricultural Organizations › Section 1682.002. Nonprofit Agricultural Organization Health Benefits Authorized

Sec. 1682.002.  NONPROFIT AGRICULTURAL ORGANIZATION HEALTH BENEFITS AUTHORIZED.  A nonprofit agricultural organization or an affiliate of the organization  may offer in this state nonprofit agricultural organization health benefits.
Added by Acts 2021, 87th Leg., R.S., Ch. 1034 (H.B. 3924), Sec. 3, eff. September 1, 2021.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle K - Certain Benefits and Arrangements That Are Not Insurance › Chapter 1682 - Health Benefits Provided by Certain Nonprofit Agricultural Organizations › Section 1682.003. Waiting Period for Preexisting Condition

Sec. 1682.003.  WAITING PERIOD FOR PREEXISTING CONDITION.  Notwithstanding any other provision of this chapter, a nonprofit agricultural organization that offers nonprofit agricultural organization health benefits may not require a waiting period of more than six months for treatment of a preexisting condition otherwise included in nonprofit agricultural organization health benefits.
Added by Acts 2021, 87th Leg., R.S., Ch. 1034 (H.B. 3924), Sec. 3, eff. September 1, 2021.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle K - Certain Benefits and Arrangements That Are Not Insurance › Chapter 1682 - Health Benefits Provided by Certain Nonprofit Agricultural Organizations › Section 1682.004. Required Disclosure by Nonprofit Agricultural Organization

Sec. 1682.004.  REQUIRED DISCLOSURE BY NONPROFIT AGRICULTURAL ORGANIZATION.  (a)  A nonprofit agricultural organization that offers nonprofit agricultural organization health benefits must provide to an individual applying for nonprofit agricultural organization health benefits written notice that the benefits are not provided through an insurance policy or other product the offering or issuance of which is regulated as the business of insurance in this state.
(b)  An individual must sign and return to the nonprofit agricultural organization the notice described by Subsection (a) before the individual may enroll in nonprofit agricultural organization health benefits.  The nonprofit agricultural organization must:
(1)  maintain a copy of the signed written notice for the duration of the term during which the nonprofit agricultural organization health benefits are provided to the individual; and
(2)  at the request of the individual, provide a copy of the written notice to the individual.
Added by Acts 2021, 87th Leg., R.S., Ch. 1034 (H.B. 3924), Sec. 3, eff. September 1, 2021.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle K - Certain Benefits and Arrangements That Are Not Insurance › Chapter 1682 - Health Benefits Provided by Certain Nonprofit Agricultural Organizations › Section 1682.005. Nonprofit Agricultural Organization Not Engaged in Business of Health Insurance

Sec. 1682.005.  NONPROFIT AGRICULTURAL ORGANIZATION NOT ENGAGED IN BUSINESS OF HEALTH INSURANCE.  Notwithstanding any other provision of this code, for the purposes of offering nonprofit agricultural organization health benefits, a nonprofit agricultural organization that acts in accordance with this chapter is not a health insurer and is not engaging in the business of health insurance in this state.
Added by Acts 2021, 87th Leg., R.S., Ch. 1034 (H.B. 3924), Sec. 3, eff. September 1, 2021.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle K - Certain Benefits and Arrangements That Are Not Insurance › Chapter 1682 - Health Benefits Provided by Certain Nonprofit Agricultural Organizations › Section 1682.006. Risk Transfer or Coverage

Sec. 1682.006.  RISK TRANSFER OR COVERAGE.  A nonprofit agricultural organization that offers nonprofit agricultural organization health benefits under this chapter may contract with a company authorized to engage in the business of insurance in this state that is not under common control with the nonprofit agricultural organization to:
(1)  transfer to that company all or a portion of the organization's risks arising from nonprofit agricultural organization health benefits offered under this chapter; or
(2)  obtain insurance coverage from the company guarantying the nonprofit agricultural organization's obligations arising from nonprofit agricultural organization health benefits offered under this chapter.
Added by Acts 2021, 87th Leg., R.S., Ch. 1034 (H.B. 3924), Sec. 3, eff. September 1, 2021.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle L - Qualified Health Plan Mandatory Disclosures › Chapter 1693 - Qualified Health Plan Identification Cards › Section 1693.001. Definitions

Sec. 1693.001.  DEFINITIONS.  Except as provided by Section 1693.003, in this chapter, "enrollee," "exchange," "qualified health plan," and "qualified health plan issuer" have the meanings assigned by 45 C.F.R. Section 155.20 as that section existed on January 1, 2015.
Added by Acts 2015, 84th Leg., R.S., Ch. 732 (H.B. 1514), Sec. 1, eff. September 1, 2015.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle L - Qualified Health Plan Mandatory Disclosures › Chapter 1693 - Qualified Health Plan Identification Cards › Section 1693.002. Required Information

Sec. 1693.002.  REQUIRED INFORMATION.  An identification card or other similar document issued by a qualified health plan issuer to an enrollee of a qualified health plan purchased through an exchange must, in addition to any requirement under other law, including Sections 843.209, 1301.162, and 1369.153, display on the card or document in a location of the issuer's choice the acronym "QHP."
Added by Acts 2015, 84th Leg., R.S., Ch. 732 (H.B. 1514), Sec. 1, eff. September 1, 2015.
Sec. 1693.003.  COMMISSIONER DETERMINATIONS REGARDING FEDERAL REGULATIONS.  (a) The commissioner shall monitor 45 C.F.R. Section 155.20 for amendments to the definitions listed in Section 1693.001 and determine if it is in the best interest of the state to adopt an amended definition for purposes of this chapter.  If the commissioner determines that it is in the best interest of the state to adopt the amended definition, the commissioner by rule shall adopt the amended definition.
(b)  In making the determination about an amendment, the commissioner shall  consider, in addition to other factors affecting the public interest, the beneficial and adverse effects the amendment may  have on:
(1)  individuals who are receiving medical care and health care services in this state; and
(2)  health care providers and physicians.
Added by Acts 2015, 84th Leg., R.S., Ch. 732 (H.B. 1514), Sec. 1, eff. September 1, 2015.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle L - Qualified Health Plan Mandatory Disclosures › Chapter 1693 - Qualified Health Plan Identification Cards › Section 1693.004. Report to Legislature

Sec. 1693.004.  REPORT TO LEGISLATURE.  The commissioner shall prepare a report of a determination made under Section 1693.003, including an explanation of the reasons for the determination, and file the report with the presiding officer of each house of the legislature not later than the 30th day after the date the determination is made.
Added by Acts 2015, 84th Leg., R.S., Ch. 732 (H.B. 1514), Sec. 1, eff. September 1, 2015.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle L - Qualified Health Plan Mandatory Disclosures › Chapter 1693 - Qualified Health Plan Identification Cards › Section 1693.005. Rules

Sec. 1693.005.  RULES.  The commissioner may adopt rules as necessary to administer and enforce this chapter.
Added by Acts 2015, 84th Leg., R.S., Ch. 732 (H.B. 1514), Sec. 1, eff. September 1, 2015.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle M - Federal Patient Protection and Affordable Care Act › Chapter 1695 - Legislative Considerations › Section 1695.001. Constitutionality of Patient Protection and Affordable Care Act

Sec. 1695.001.  CONSTITUTIONALITY OF PATIENT PROTECTION AND AFFORDABLE CARE ACT.  This subtitle does not constitute an acknowledgment by the legislature of the legitimacy of the Patient Protection and Affordable Care Act (Pub. L. No. 111-148) as a constitutional exercise of the power of the United States Congress.
Added by Acts 2017, 85th Leg., 1st C.S., Ch. 5 (H.B. 214), Sec. 1, eff. December 1, 2017.