The bill, S.B. No. 926, aims to amend the Texas Insurance Code to establish guidelines for 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 imposes a fiduciary duty on 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 stipulates that health benefit plan issuers can only rank physicians based on standards developed by designated organizations and requires that affected physicians be notified of their rankings at least 45 days prior to public dissemination. The bill also includes provisions for physicians to dispute discrepancies in their rankings. Overall, the legislation seeks to enhance transparency and accountability in the practices of health benefit plan issuers while promoting the use of specific 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 1460, Insurance Code 1301)