SECTION 357.405. Insurance Payments

(a) If the consumer has medical and dental insurance that covers an independent living service received by the consumer and the agreement for in-network services made between the insurance company and the service provider or service provider's subcontractor requires that the service provider or subcontractor accept as payment in full the deductible, copayment, or coinsurance and insurance reimbursement, then the consumer's fee for service is either the deductible, copayment, or coinsurance, or the amount calculated by the DARS fee schedule, whichever is less.

(b) The consumer pays the premiums for medical and dental insurance. Neither DARS nor the service provider pays the premiums.

(c) The premiums for medical and dental insurance do not count toward meeting the consumer's fee for service.

Source Note: The provisions of this §357.405 adopted to be effective August 31, 2016, 41 TexReg 6066; transferred effective March 15, 2021, as published in the Texas Register February 26, 2021, 46 TexReg 1387