Tex. Ins. Code Section 1301.0045
Construction of Chapter


(a)

Except as provided by Section 1301.0046 (Coinsurance Requirements for Services of Nonpreferred Providers), this chapter may not be construed to limit the level of reimbursement or the level of coverage, including deductibles, copayments, coinsurance, or other cost-sharing provisions, that are applicable to preferred providers or, for plans other than exclusive provider benefit plans, nonpreferred providers.

(b)

Except as provided by Sections 1301.0052 (Exclusive Provider Benefit Plans: Referrals for Medically Necessary Services), 1301.0053 (Exclusive Provider Benefit Plans: Emergency Care), 1301.155 (Emergency Care), 1301.164 (Out-of-network Facility-based Providers), 1301.165 (Out-of-network Diagnostic Imaging Provider or Laboratory Service Provider), and 1301.166 (Out-of-network Emergency Medical Services Provider), this chapter may not be construed to require an exclusive provider benefit plan to compensate a nonpreferred provider for services provided to an insured.

(b)

Except as provided by Sections 1301.0052 (Exclusive Provider Benefit Plans: Referrals for Medically Necessary Services), 1301.0053 (Exclusive Provider Benefit Plans: Emergency Care), 1301.155 (Emergency Care), 1301.164 (Out-of-network Facility-based Providers), and 1301.165 (Out-of-network Diagnostic Imaging Provider or Laboratory Service Provider), this chapter may not be construed to require an exclusive provider benefit plan to compensate a nonpreferred provider for services provided to an insured.
Added by Acts 2005, 79th Leg., Ch. 1221 (H.B. 1030), Sec. 1, eff. September 1, 2005.
Amended by:
Acts 2011, 82nd Leg., R.S., Ch. 288 (H.B. 1772), Sec. 6, eff. September 1, 2011.
Acts 2019, 86th Leg., R.S., Ch. 1342 (S.B. 1264), Sec. 1.05, eff. September 1, 2019.
Acts 2023, 88th Leg., R.S., Ch. 981 (S.B. 2476), Sec. 6(a), eff. September 1, 2023.
Acts 2023, 88th Leg., R.S., Ch. 981 (S.B. 2476), Sec. 6(b), eff. September 1, 2025.

Source: Section 1301.0045 — Construction of Chapter, https://statutes.­capitol.­texas.­gov/Docs/IN/htm/IN.­1301.­htm#1301.­0045 (accessed Dec. 2, 2023).

1301.001
Definitions
1301.002
Nonapplicability to Dental Care Benefits
1301.003
Preferred Provider Benefit Plans and Exclusive Provider Benefit Plans Permitted
1301.005
Availability of Preferred Providers
1301.006
Availability of and Accessibility to Health Care Services
1301.007
Rules
1301.008
Conflict with Other Law
1301.009
Annual Report
1301.010
Balance Billing Prohibition Notice
1301.0041
Applicability
1301.0042
Applicability of Insurance Law
1301.0045
Construction of Chapter
1301.0046
Coinsurance Requirements for Services of Nonpreferred Providers
1301.0051
Exclusive Provider Benefit Plans: Quality Improvement and Utilization Management
1301.051
Designation as Preferred Provider
1301.0052
Exclusive Provider Benefit Plans: Referrals for Medically Necessary Services
1301.052
Designation of Advanced Practice Nurse or Physician Assistant as Preferred Provider
1301.053
Appeal Relating to Designation as Preferred Provider
1301.0053
Exclusive Provider Benefit Plans: Emergency Care
1301.054
Notice to Practitioners of Preferred Provider Benefit Plan
1301.0055
Network Adequacy Standards
1301.055
Complaint Resolution
1301.0056
Examinations and Fees
1301.056
Restrictions on Payment and Reimbursement
1301.057
Termination of Participation
1301.0057
Access to Out-of-network Providers
1301.058
Economic Profiling
1301.0058
Protected Communications by Preferred Providers
1301.059
Quality Assessment
1301.060
Compensation on Discounted Fee Basis
1301.0061
Terms of Enrollee Eligibility
1301.061
Preferred Provider Networks
1301.062
Preferred Provider Contracts Between Insurers and Podiatrists
1301.063
Contract Provisions Relating to Use of Hospitalist
1301.064
Contract Provisions Relating to Payment of Claims
1301.065
Shifting of Insurer’s Tort Liability Prohibited
1301.066
Retaliation Against Preferred Provider Prohibited
1301.067
Interference with Relationship Between Patient and Physician or Health Care Provider Prohibited
1301.068
Inducement to Limit Medically Necessary Services Prohibited
1301.069
Services Provided by Certain Physicians and Health Care Providers
1301.101
Definition
1301.102
Submission of Claim
1301.103
Deadline for Action on Clean Claims
1301.104
Deadline for Action on Pharmacy Claims
1301.105
Audited Claims
1301.106
Claims Processing Procedures and Claims Payment Processes
1301.107
Contractual Waiver and Other Actions Prohibited
1301.108
Attorney’s Fees
1301.109
Applicability to Entities Contracting with Insurer
1301.131
Elements of Clean Claim
1301.132
Overpayment
1301.133
Verification
1301.134
Coordination of Payment
1301.135
Preauthorization of Medical and Health Care Services
1301.136
Availability of Coding Guidelines
1301.137
Violation of Claims Payment Requirements
1301.138
Applicability to Entities Contracting with Insurer
1301.139
Legislative Declaration
1301.140
Out-of-pocket Expense Credit
1301.151
Insured’s Right to Treatment
1301.152
Continuing Care in General
1301.153
Continuity of Care
1301.154
Obligation for Continuity of Care of Insurer
1301.155
Emergency Care
1301.156
Payment of Claims to Insured
1301.157
Plain Language Requirements
1301.158
Information Concerning Preferred Provider Benefit Plans
1301.159
Annual List of Preferred Providers
1301.160
Notification of Termination of Participation of Preferred Provider
1301.161
Retaliation Against Insured Prohibited
1301.162
Identification Card
1301.163
Applicability of Subchapter to Entities Contracting with Insurer
1301.164
Out-of-network Facility-based Providers
1301.165
Out-of-network Diagnostic Imaging Provider or Laboratory Service Provider
1301.166
Out-of-network Emergency Medical Services Provider
1301.201
Contracts with and Reimbursement for Nurse First Assistants
1301.202
Contracts with Hospitals
1301.0515
Acupuncturist Services
1301.0516
Chiropractic Services
1301.0521
Designation of Certain Podiatrists as Preferred Providers
1301.0522
Designation of Certain Optometrists, Therapeutic Optometrists, and Ophthalmologists as Preferred Providers
1301.00553
Maximum Travel Time and Distance Standards by Preferred Provider Type
1301.00554
Other Maximum Distance Standard Requirements
1301.00555
Maximum Appointment Wait Time Standards
1301.00565
Public Hearing on Network Adequacy Standards Waivers
1301.00566
Effect of Network Adequacy Standards Waiver on Balance Billing Prohibitions
1301.0625
Health Care Collaboratives
1301.0641
Contract Provisions Prohibiting Rejection of Batched Claims
1301.0642
Contract Provisions Allowing Certain Adverse Material Changes Prohibited
1301.1021
Receipt of Claim
1301.1051
Completion of Audit
1301.1052
Preferred Provider Appeal After Audit
1301.1053
Deadlines Not Extended
1301.1054
Requests for Additional Information
1301.1351
Posting of Preauthorization Requirements
1301.1352
Changes to Preauthorization Requirements
1301.1353
Remedy for Noncompliance
1301.1581
Information Concerning Exclusive Provider Benefit Plans
1301.1591
Preferred Provider Information on Internet

Accessed:
Dec. 2, 2023

§ 1301.0045’s source at texas​.gov