TX SB622

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, codifying the "prudent layperson" standard

Requires health benefit plans to cover emergency services based on the patient's presenting symptoms at the time of seeking care, not based on what the condition ultimately turns out to be after evaluation

Modifies the definition of "utilization review" to explicitly include determinations that services do not meet the definition of emergency care, subjecting such denials to utilization review requirements

Applies to health maintenance organizations (HMOs), preferred provider benefit plans, and utilization review processes under Chapters 843, 1301, and 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