Texas § IN.1504.055 - PROCEDURE FOR CLAIMS

§ IN.1504.055. PROCEDURE FOR CLAIMS

PROCEDURE FOR CLAIMS. (a) A benefit plan issuer that provides health or dental coverage to a child through a covered parent of the child shall: (1) provide to each custodial parent of the child or to an adult child documents and other information necessary for the child to obtain benefits under the coverage, including: (A) the name of the issuer; (B) the number of the policy or evidence of coverage; (C) a copy of the policy or evidence of coverage and schedule of benefits; (D) a health or dental coverage membership card; (E) claim forms; and (F) any other document or information necessary to submit a claim in accordance with the issuer's policies and procedures; (2) permit a custodial parent, health care provider, state agency that has been assigned medical or dental support rights, or adult child to submit claims for covered services without the approval of the covered parent; and (3) make payments on covered claims submitted in accordance with this subsection directly to a custodial parent, health care or dental care provider, adult child, or state agency making a claim. (b) A benefit plan issuer shall provide to a state agency that provides medical assistance, including medical assistance for dental services, to the child or shall provide to a child support agency that enforces medical or dental support on behalf of a child the information necessary to obtain reimbursement of medical or dental services provided to or paid on behalf of the child. Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005. Amended by: Acts 2015, 84th Leg., R.S., Ch. 1150 (S.B. 550 ), Sec. 68, eff. September 1, 2018. SUBCHAPTER C. PROHIBITED CONDUCT