|(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