| 1 | 1 | | 89R2890 MEW-D |
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| 2 | 2 | | By: Lalani H.B. No. 428 |
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| 3 | 3 | | |
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| 4 | 4 | | |
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| 5 | 5 | | |
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| 6 | 6 | | |
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| 7 | 7 | | A BILL TO BE ENTITLED |
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| 8 | 8 | | AN ACT |
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| 9 | 9 | | relating to identification cards issued by health maintenance |
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| 10 | 10 | | organizations and preferred provider organizations. |
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| 11 | 11 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 12 | 12 | | SECTION 1. Section 843.209, Insurance Code, is amended to |
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| 13 | 13 | | read as follows: |
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| 14 | 14 | | Sec. 843.209. IDENTIFICATION CARD. (a) An identification |
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| 15 | 15 | | card or other similar document issued by a health maintenance |
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| 16 | 16 | | organization to an enrollee must: |
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| 17 | 17 | | (1) indicate that the health maintenance organization |
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| 18 | 18 | | is regulated under this code and subject to the provisions of |
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| 19 | 19 | | Subchapter J; [and] |
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| 20 | 20 | | (2) display: |
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| 21 | 21 | | (A) the first date on which the enrollee became |
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| 22 | 22 | | enrolled; or |
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| 23 | 23 | | (B) a toll-free number a physician or provider |
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| 24 | 24 | | may use to obtain that date; and |
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| 25 | 25 | | (3) display the acronym "HMO" in the location of the |
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| 26 | 26 | | health maintenance organization's choice. |
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| 27 | 27 | | (b) An identification card or other similar document that |
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| 28 | 28 | | bears the acronym "HMO" as required by Subsection (a) indicates |
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| 29 | 29 | | that health benefit coverage for health care services provided by a |
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| 30 | 30 | | participating physician or provider does not ensure the enrollee |
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| 31 | 31 | | has access to: |
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| 32 | 32 | | (1) health care services at a discounted rate if the |
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| 33 | 33 | | services are provided by a physician or provider who is not included |
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| 34 | 34 | | in the health maintenance organization delivery network; or |
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| 35 | 35 | | (2) other fee discounts available under the health |
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| 36 | 36 | | maintenance organization delivery network. |
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| 37 | 37 | | SECTION 2. Section 1301.162, Insurance Code, is amended to |
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| 38 | 38 | | read as follows: |
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| 39 | 39 | | Sec. 1301.162. IDENTIFICATION CARD. (a) An identification |
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| 40 | 40 | | card or other similar document issued by an insurer regulated by |
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| 41 | 41 | | this code and subject to this chapter to an individual insured must: |
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| 42 | 42 | | (1) display: |
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| 43 | 43 | | (A) [(1)] the first date on which the individual |
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| 44 | 44 | | became insured under the plan; or |
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| 45 | 45 | | (B) [(2)] a toll-free number a physician or |
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| 46 | 46 | | health care provider may use to obtain that date; and |
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| 47 | 47 | | (2) display the acronym "PPO" in the location of the |
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| 48 | 48 | | insurer's choice. |
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| 49 | 49 | | (b) An identification card or other similar document that |
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| 50 | 50 | | bears the acronym "PPO" as required by Subsection (a) indicates |
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| 51 | 51 | | that health benefit coverage for medical care or health care |
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| 52 | 52 | | services provided by a preferred provider does not ensure the |
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| 53 | 53 | | insured has access to: |
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| 54 | 54 | | (1) medical care or health care services at a |
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| 55 | 55 | | discounted rate if the services are provided by an out-of-network |
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| 56 | 56 | | provider; or |
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| 57 | 57 | | (2) other fee discounts available under the provider |
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| 58 | 58 | | network. |
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| 59 | 59 | | SECTION 3. Sections 843.209 and 1301.162, Insurance Code, |
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| 60 | 60 | | as amended by this Act, apply only to an identification card or |
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| 61 | 61 | | other similar document issued on or after January 1, 2026. |
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| 62 | 62 | | SECTION 4. This Act takes effect September 1, 2025. |
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