TX HB1635

Amends the definition of "emergency care" in the Texas Insurance Code to specify that coverage applies "regardless of the final diagnosis" of the medical condition, preventing insurers from retroactively denying emergency room claims based on the ultimate diagnosis

Codifies the "prudent layperson" standard, requiring coverage for emergency services when a reasonable person would believe immediate care is needed to prevent serious health jeopardy, bodily impairment, organ dysfunction, disfigurement, or fetal harm for pregnant women

Expands the definition of "utilization review" to explicitly include determinations that services do not meet the definition of emergency care, subjecting such denials to existing utilization review regulations and appeal processes

Applies to health benefit plans under HMO regulations (Chapter 843), preferred provider benefit plans (Chapter 1301), and utilization review provisions (Chapter 4201) of the Insurance Code

Takes effect September 1, 2025, and applies only to health benefit plans delivered, issued, or renewed on or after January 1, 2026