The bill, titled H.B. No. 1959, aims to amend the Texas Insurance Code to regulate the practices of health benefit plan issuers regarding the encouragement of using specific physicians and health care providers. It introduces new provisions that allow health maintenance organizations and insurers to offer incentives, such as modified deductibles and copayments, to enrollees who choose certain providers. Additionally, it establishes a fiduciary duty for these organizations to ensure that any incentives provided are primarily for the benefit of the enrollees or policyholders.

Furthermore, the bill modifies existing regulations concerning the ranking and classification of physicians. It prohibits health benefit plan issuers from ranking physicians unless the standards used are developed by a designated organization and ensures that affected physicians are informed of their rankings in advance. The bill also mandates that any discrepancies reported by physicians must be addressed by the health benefit plan issuer within a specified timeframe. The changes aim to enhance transparency and fairness in the ranking process while promoting the use of certain health care providers. The act is set to take effect on September 1, 2025.

Statutes affected:
Introduced: Insurance Code 1301.0045, Insurance Code 1460.003, Insurance Code 1460.005 (Insurance Code 1301, Insurance Code 1460)