The bill, S.B. No. 2805, amends the Texas Insurance Code to clarify the definition of "out-of-network provider" and to establish new procedures for arbitration related to out-of-network health benefit claims. Specifically, it expands the definition to include a group of out-of-network providers identified by a National Provider Identification Number, a group National Provider Identification Number, or an Employer Identification Number. This change aims to provide clearer guidelines for identifying out-of-network providers in the context of health benefit plans.

Additionally, the bill modifies the arbitration process by stipulating that the losing party must pay the arbitrator's fees and expenses within 30 days of receiving the written decision, rather than splitting the costs between parties. The changes will take effect for health care services provided on or after January 1, 2026, while services provided before that date will continue to be governed by the previous law. The bill is set to take effect on September 1, 2025.

Statutes affected:
Introduced: Insurance Code 1467.087 (Insurance Code 1467)