The bill, S.B. No. 1156, introduces Chapter 1462 to the Texas Insurance Code, which establishes regulations regarding the conduct of health benefit plan issuers in relation to affiliated and nonaffiliated providers. It defines "affiliated provider" as a healthcare provider that is under common control with a health benefit plan issuer, while "nonaffiliated provider" refers to those that are not. The chapter outlines that health benefit plan issuers are prohibited from offering higher reimbursement rates to nonaffiliated providers based on conditions that require them to join an affiliated provider. Additionally, issuers cannot reimburse affiliated providers at rates higher than those paid to nonaffiliated providers for the same services.

The bill also prohibits health benefit plan issuers from encouraging patients to use affiliated providers through various forms of communication and from requiring patients to use affiliated providers to receive maximum benefits. It allows exceptions for providers that accept lower reimbursement rates or are part of risk-sharing arrangements. The provisions of this chapter will apply to health benefit plans delivered or renewed on or after January 1, 2026, and the act will take effect on September 1, 2025.

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