Texas House Bill HB4046

Texas 2025 - 89th Regular

• Filed: 3/7/25

Caption

Relating to an enrollee's cost-sharing liability for emergency care under a health benefit plan.

Impact

The bill is expected to have a significant impact on the landscape of health insurance in Texas, particularly relating to emergency coverage. By mandating that health benefit plan issuers pay healthcare providers the full amount due under the terms of an enrollee's plan, the legislation aims to streamline the billing processes and prevent healthcare providers from billing enrollees for additional expenses beyond their cost-sharing obligations. This change addresses a common issue where patients are often billed for costs deemed 'out-of-network' or excessive due to lack of clarity around their liabilities in emergency situations.

Summary

House Bill 4046 focuses on regulating the cost-sharing liability of enrollees for emergency care services under health benefit plans. The bill amends the Insurance Code by introducing Chapter 1224, which specifically defines cost-sharing liability and establishes requirements and prohibitions for health plan issuers. The goal of this legislation is to protect patients from unexpected out-of-pocket costs when they seek emergency care, ensuring that their financial responsibility does not exceed prescribed amounts such as copayments or coinsurance.

Contention

There are potential points of contention surrounding the enforcement of this bill. Critics may argue about the implications for healthcare providers regarding reimbursement and the pressures it places on both insurance companies and medical practices. Concerns may arise about whether health issuers will be able to adjust premiums or coverage options in reaction to increased responsibilities. Additionally, some stakeholders may express worries that these limitations on billing could disincentivize the development of a competitive market among insurance providers, potentially affecting overall care quality and availability.