Tex.
Ins. Code Section 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.
Source:
Section 1662.054 — Internet-based Self-service Tool, https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1662.htm#1662.054 (accessed May 11, 2024).
