H.B. No. 4102 introduces new regulations for health benefit plan issuers regarding their interactions with affiliated and nonaffiliated healthcare providers. The bill establishes Chapter 1462 in the Insurance Code, defining "affiliated provider" as one that is controlled by or shares common control with a health benefit plan issuer, while "nonaffiliated provider" is one that does not have such a relationship. The chapter outlines that health benefit plans must not offer higher reimbursement rates to nonaffiliated providers based on conditions that require them to join an affiliated provider network. Additionally, it prohibits issuers from paying affiliated providers more than nonaffiliated providers for the same services, with exceptions for value-based or capitation reimbursement arrangements.

The bill also restricts communications and referrals that encourage patients to use affiliated providers. Specifically, it prohibits health benefit plan issuers from requiring patients to use affiliated providers to receive maximum benefits, offering reduced cost-sharing for using affiliated providers, or soliciting patients to transfer prescriptions to affiliated providers. However, issuers can still promote affiliated providers under certain conditions, such as when they 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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