House Bill No. 3943 introduces Chapter 1462 to the Insurance Code, which outlines the prohibited conduct of health benefit plan issuers regarding affiliated and nonaffiliated providers. The bill 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 explicitly excludes certain programs such as Medicaid and workers' compensation insurance.

The bill prohibits health benefit plan issuers from offering higher reimbursement rates to nonaffiliated providers based on conditions that require them to join an affiliated provider network. It also restricts issuers from encouraging patients to use affiliated providers through communications or requiring patients to use them to receive maximum benefits. However, exceptions are made for cases where affiliated providers accept lower reimbursement rates or are part of risk-sharing arrangements. The provisions of this chapter will take effect for health benefit plans delivered or renewed on or after January 1, 2026, with the overall act becoming effective on September 1, 2025.

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