Tex. Ins. Code § 1274.002 · Chapter 1274. ELECTRONIC TRANSMISSION OF ELIGIBILITY AND PAYMENT STATUS
TRANSMISSION OF ENROLLEE ELIGIBILITY AND PAYMENT STATUS.
Text — Current through the 89th 2nd Called Legislative Session, 2025
(a) Each health benefit plan issuer shall, upon the participating provider's submission of the patient's name, relationship to the primary enrollee, and birth date, make available telephonically, electronically, or by an Internet website portal to each participating provider information maintained in the ordinary course of business and sufficient for the provider to determine at the time of the enrollee's visit information concerning:
(1) the enrollee, including:
(A) the enrollee's identification number assigned by the health benefit plan issuer;
(B) the name of the enrollee and all covered dependents, if appropriate;
(C) the birth date of the enrollee and the birth dates of all covered dependents, if appropriate;
(D) the gender of the enrollee and the gender of each covered dependent, if appropriate; and
(E) the current enrollment and eligibility status of the enrollee under the health benefit plan;
(2) the enrollee's benefits, including:
(A) whether a specific type or category of service is a covered benefit; and
(B) excluded benefits or limitations, both group and individual; and
(3) the enrollee's financial information, including:
(A) copayment requirements, if any; and
(B) the unmet amount of the enrollee's deductible or enrollee financial responsibility.
(b) Information required to be made available under this section may be made available only to a participating provider who is authorized under state and federal law to receive personally identifiable information on an enrollee or dependent.
Notes and commentary — not statutory text
History
Added by Acts 2005, 79th Leg., Ch. 880 (S.B. 1149), Sec. 1, eff. September 1, 2005.
Source of truth
- Edition
- Current through the 89th 2nd Called Legislative Session, 2025
- Official file
- https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1274.htm
- Text hash
- sha256 2287cc4ca5a6648f81ec7ee122fd36a3aa941d140fe2a8a803a6e43dac65ca05
- Composed by
- compose_tx.py 2026-10-05: the Legislative Council's chapter files read in document order; verify_tx.py's independent reading (lxml DOM walk) agrees character for character
Cited by 1 provision
Provisions in this library whose text cites Tex. Ins. Code § 1274.002. Each shows the citation as that text prints it.
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