The bill, S.B. No. 1156, introduces Chapter 1462 to the Texas Insurance Code, which outlines the prohibited conduct of health benefit plan issuers regarding 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 applies to various health benefit plans, including individual and group insurance policies, but excludes certain programs such as Medicaid and workers' compensation.

Key provisions of the bill prohibit health benefit plan issuers from offering higher reimbursement rates to nonaffiliated providers based on conditions that require them to join an affiliated provider network. Additionally, issuers cannot pay affiliated providers more than nonaffiliated providers for the same services. The bill also restricts issuers from encouraging patients to use affiliated providers through communications or requiring patients to use them to receive maximum benefits. These regulations aim to ensure fair treatment of both affiliated and nonaffiliated providers and will take effect for plans issued or renewed on or after January 1, 2026.

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