Requirements

A health benefit plan:

1. must provide coverage for a covered health care service or procedure delivered by a preferred or contracted health professional to a covered patient as a telemedicine medical service, teledentistry dental service, or telehealth service on the same basis and to the same extent that the plan provides coverage for the service or procedure in an in-person setting; and
2. may not:
   1. exclude from coverage a covered health care service or procedure delivered by a preferred or contracted health professional to a covered patient as a telemedicine medical service, a teledentistry dental service, or a telehealth service solely because the covered health care service or procedure is not provided through an in-person consultation; and
   2. subject to Subsection (c), limit, deny, or reduce coverage for a covered health care service or procedure delivered as a telemedicine medical service, teledentistry dental service, or telehealth service based on the health professional’s choice of platform for delivering the service or procedure.

A health benefit plan may require a deductible, a copayment, or coinsurance for a covered health care service or procedure delivered by a preferred or contracted health professional to a covered patient as a telemedicine medical service, a teledentistry dental service, or a telehealth service. The amount of the deductible, copayment, or coinsurance may not exceed the amount of the deductible, copayment, or coinsurance required for the covered health care service or procedure provided through an in-person consultation.

A health benefit plan must provide coverage for a covered health care service or procedure delivered as a telemedicine medical service, teledentistry dental service, or telehealth service with an originating site or distant site located outside this state on the same basis and to the same extent that the plan provides coverage for the service or procedure delivered as a telemedicine medical service, teledentistry dental service, or telehealth service with an originating site and distant site located in this state if:

• the individual who receives the service resides primarily in this state; and
• the health professional who provides the service:
  • is licensed or otherwise authorized to provide the service in this state; and
  • has a physical office in this state.

SOURCE: TX Insurance Code Sec. 1455.004 (Accessed Jan. 2026).

Each issuer of a health benefit plan shall adopt and display in a conspicuous manner on the health benefit plan issuer’s Internet website the issuer’s policies and payment practices for telemedicine medical services, teledentistry dental services, and telehealth services.

SOURCE: TX Insurance Code Sec. 1455.006. (Accessed Jan. 2026).

Each evidence of coverage or certificate delivered or issued for delivery by an HMO may provide enrollees the option to access covered health care services through a telehealth service or telemedicine service.

SOURCE: Texas Admin Code, Title 28, Part 1, Ch. 11, Subchapter Q, Sec. 11.1607, (Accessed Jan. 2026).

Worker’s Compensation

A health care provider may bill and be reimbursed for telemedicine, telehealth, or teledentistry services regardless of where the injured employee is located at the time the telemedicine, telehealth, or teledentistry services are provided.

The provisions of this section take precedence over any conflicting provisions adopted or used by:

• the Centers for Medicare and Medicaid Services in administering the Medicare program; and
• the Texas Health and Human Services Commission in administering the Texas Medicaid Program.

SOURCE:  TX Admin Code Title 28, Part 2, Subch B, 28 TAC 133.30, (Accessed Jan. 2026).

In providing covered benefits to a child, a health plan provider must permit benefits to be provided through telemedicine medical services, teledentistry dental services, and telehealth services in accordance with policies developed by the commission.

The policies must provide for:

• the availability of covered benefits appropriately provided through telemedicine medical services, teledentistry dental services, and telehealth services that are comparable to the same types of covered benefits provided without the use of telemedicine medical services, teledentistry dental services, and telehealth services; and
• the availability of covered benefits for different services performed by multiple health care providers during a single session of telemedicine medical services, teledentistry dental services, or both services, or of telehealth services, if the executive commissioner determines that delivery of the covered benefits in that manner is cost-effective in comparison to the costs that would be involved in obtaining the services from providers without the use of telemedicine medical services, teledentistry dental services, or telehealth services, including the costs of transportation and lodging and other direct costs.

SOURCE: Health and Safety Code 62.1571, (Accessed Jan. 2026).

An insurer must submit network configuration information as specified in this section in connection with a request for a waiver under §3.3707 of this title (relating to Waiver Due to Failure to Contract in Local Markets), an annual network adequacy report required under §3.3709 of this title (relating to Annual Network Adequacy Report), or an application for a network modification under §3.3722 of this title (relating to Application for Preferred and Exclusive Provider Benefit Plan Approval; Qualifying Examination; Network Modifications).

…

A network configuration filing must contain the following items.

• Provider listing data. The insurer must use the provider listings form available at www.tdi.texas.gov to provide a comprehensive searchable and sortable listing of physicians and health care providers in the plan’s network that includes: …
  • whether the preferred provider offers telemedicine or telehealth

SOURCE: TX Insurance Code Part 1, Ch. 3, Subch. X, Div. 1, Rule Sec. 3.3712, (Accessed Jan. 2026).