89R2890 MEW-D
By: Lalani H.B. No. 428
A BILL TO BE ENTITLED
AN ACT
relating to identification cards issued by health maintenance
organizations and preferred provider organizations.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 843.209, Insurance Code, is amended to
read as follows:
Sec. 843.209. IDENTIFICATION CARD. (a) An identification
card or other similar document issued by a health maintenance
organization to an enrollee must:
(1) indicate that the health maintenance organization
is regulated under this code and subject to the provisions of
Subchapter J; [and]
(2) display:
(A) the first date on which the enrollee became
enrolled; or
(B) a toll-free number a physician or provider
may use to obtain that date; and
(3) display the acronym "HMO" in the location of the
health maintenance organization's choice.
(b) An identification card or other similar document that
bears the acronym "HMO" as required by Subsection (a) indicates
that health benefit coverage for health care services provided by a
participating physician or provider does not ensure the enrollee
has access to:
(1) health care services at a discounted rate if the
services are provided by a physician or provider who is not included
in the health maintenance organization delivery network; or
(2) other fee discounts available under the health
maintenance organization delivery network.
SECTION 2. Section 1301.162, Insurance Code, is amended to
read as follows:
Sec. 1301.162. IDENTIFICATION CARD. (a) An identification
card or other similar document issued by an insurer regulated by
this code and subject to this chapter to an individual insured must:
(1) display:
(A) [(1)] the first date on which the individual
became insured under the plan; or
(B) [(2)] a toll-free number a physician or
health care provider may use to obtain that date; and
(2) display the acronym "PPO" in the location of the
insurer's choice.
(b) An identification card or other similar document that
bears the acronym "PPO" as required by Subsection (a) indicates
that health benefit coverage for medical care or health care
services provided by a preferred provider does not ensure the
insured has access to:
(1) medical care or health care services at a
discounted rate if the services are provided by an out-of-network
provider; or
(2) other fee discounts available under the provider
network.
SECTION 3. Sections 843.209 and 1301.162, Insurance Code,
as amended by this Act, apply only to an identification card or
other similar document issued on or after January 1, 2026.
SECTION 4. This Act takes effect September 1, 2025.