By: Frank (Senate Sponsor - Hancock) H.B. No. 2414
(In the Senate - Received from the House May 3, 2023;
May 12, 2023, read first time and referred to Committee on Health &
Human Services; May 21, 2023, reported favorably by the following
vote: Yeas 8, Nays 0, one present not voting; May 21, 2023, sent to
printer.)
Click here to see the committee vote
A BILL TO BE ENTITLED
AN ACT
relating to certain practices of a health maintenance organization
or insurer to encourage the use of certain physicians and health
care providers.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter I, Chapter 843, Insurance Code, is
amended by adding Section 843.322 to read as follows:
Sec. 843.322. INCENTIVES TO USE CERTAIN PHYSICIANS OR
PROVIDERS. (a) A health maintenance organization may provide
incentives for enrollees to use certain physicians or providers
through modified deductibles, copayments, coinsurance, or other
cost-sharing provisions.
(b) A health maintenance organization that encourages an
enrollee to obtain a health care service from a particular
physician or provider, including offering incentives to encourage
enrollees to use specific physicians or providers, or that
introduces or modifies a tiered network plan or assigns physicians
or providers into tiers, has a fiduciary duty to the enrollee or
group contract holder to engage in that conduct only for the primary
benefit of the enrollee or group contract holder.
SECTION 2. Section 1301.0045(a), Insurance Code, is amended
to read as follows:
(a) Except as provided by Sections [Section] 1301.0046 and
1301.0047, this chapter may not be construed to limit the level of
reimbursement or the level of coverage, including deductibles,
copayments, coinsurance, or other cost-sharing provisions, that
are applicable to preferred providers or, for plans other than
exclusive provider benefit plans, nonpreferred providers.
SECTION 3. Subchapter A, Chapter 1301, Insurance Code, is
amended by adding Section 1301.0047 to read as follows:
Sec. 1301.0047. INCENTIVES TO USE CERTAIN PHYSICIANS OR
HEALTH CARE PROVIDERS. (a) An insurer may provide incentives for
insureds to use certain physicians or health care providers through
modified deductibles, copayments, coinsurance, or other
cost-sharing provisions.
(b) An insurer that encourages an insured to obtain a health
care service from a particular physician or health care provider,
including offering incentives to encourage insureds to use specific
physicians or providers, or that introduces or modifies a tiered
network plan or assigns physicians or providers into tiers, has a
fiduciary duty to the insured or policyholder to engage in that
conduct only for the primary benefit of the insured or
policyholder.
SECTION 4. This Act takes effect September 1, 2023.
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