Tex.
Ins. Code Section 1662.105
Out-of-network Allowed Amounts
(a)
An out-of-network allowed amount provided under Section 1662.103 (Required Information)(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 (Required Information)(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 (Required Information)(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.
Source:
Section 1662.105 — Out-of-network Allowed Amounts, https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1662.htm#1662.105 (accessed May 18, 2024).
