HB 3414
AN ACT relating to preferred provider benefit plan out-of-pocket expense
89th Regular Session
Jan 14, 2025 - Jun 2, 2025 • Session ended
Awaiting Committee Assignment
Bill filed, pending referral to House committee
Committee
Not yet assigned
Fiscal Note
Not available
What This Bill Does
Requires insurance companies to treat direct primary care fees as medically necessary service costs for preferred provider benefit plans. It means patients paying a direct fee to a physician for primary care services can have those payments counted towards their out-of-pocket expenses and insurance coverage. The law will apply to insurance plans delivered, issued, or renewed on or after January 1, 2025.
Subject Areas
Bill Text
relating to preferred provider benefit plan out-of-pocket expense credits for payments made by an insured directly to a physician BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: SECTION 1. Section 1301.140, Insurance Code, is amended by adding Subsection (a-1) to read as follows: (a-1) For purposes of Subsection (a), an insurer who provides coverage for primary care services shall treat a direct fee charged by a physician who provides direct primary care as a fee for a medically necessary covered medical or health care service or supply. In this subsection, "direct fee" and "direct primary care" have the meanings assigned by Section 162.251, Occupations Code. SECTION 2. Section 1301.140(a-1), Insurance Code, as added by this Act, applies only to a preferred provider benefit plan that is delivered, issued for delivery, or renewed on or after January 1, SECTION 3. This Act takes effect September 1, 2025.
Bill History
Bill filed: AN ACT relating to preferred provider benefit plan out-of-pocket expense
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