The bill, H.B. No. 5343, amends the Texas Insurance Code to establish guidelines for the reimbursement and payment of claims by health benefit plan issuers for telemedicine, teledentistry, and telehealth services. It defines "health professional" to include not only physicians and dentists but also licensed or certified individuals who assist in providing these services under supervision, as well as mental health professionals meeting specific educational and competency criteria. The bill introduces new sections that mandate health benefit plan issuers to reimburse contracted health professionals for telehealth services at least at the same rate as in-person services, while also outlining conditions under which issuers are not required to pay more than billed charges or reimburse for services provided under risk-based payment arrangements.

Additionally, the bill prohibits health benefit plan issuers from requiring excessive documentation for telehealth claims beyond what is necessary for in-person services. It also states that the provisions of this chapter cannot be waived or nullified by contract. The changes will apply to health benefit plans delivered or renewed on or after January 1, 2026, with the law prior to this amendment remaining in effect for plans issued before that date. The act is set to take effect on September 1, 2025.

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