The bill, H.B. No. 5099, proposes the establishment of a shared savings program for certain managed care plans in Texas, which is to be added as Chapter 1276 to the Insurance Code. This chapter includes definitions for key terms such as "health care provider," "managed care plan," and "out-of-network provider." It outlines the applicability of the chapter to nonemergency health care services covered under specific health benefit plans, including those provided by health maintenance organizations and preferred provider benefit plans. The bill mandates that health benefit plan issuers or administrators create a shared savings program, provide written notice to enrollees, and establish a toll-free number and website for enrollees to request information about average contracted rates for health care services.

Additionally, the bill stipulates that if an enrollee receives a service at a cost lower than the disclosed average contracted rate, the issuer or administrator must pay the enrollee 50% of the difference, provided the difference is at least $50. It also includes provisions for deductibles and liability for unforeseen charges that exceed estimates provided by out-of-network providers. The new regulations will apply to health benefit plans delivered or renewed on or after January 1, 2026, and the act is set to take effect on September 1, 2025.

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