Texas § IN.1662.054 - INTERNET-BASED SELF-SERVICE TOOL

§ IN.1662.054. INTERNET-BASED SELF-SERVICE TOOL

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. Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090 ), Sec. 3, eff. September 1, 2021.