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  88R21664 CJD-F
 
  By: Frank H.B. No. 2414
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to certain practices of a health maintenance organization
  or insurer to encourage the use of certain physicians and health
  care providers.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subchapter I, Chapter 843, Insurance Code, is
  amended by adding Section 843.322 to read as follows:
         Sec. 843.322.  INCENTIVES TO USE CERTAIN PHYSICIANS OR
  PROVIDERS. (a)  A health maintenance organization may provide
  incentives for enrollees to use certain physicians or providers
  through modified deductibles, copayments, coinsurance, or other
  cost-sharing provisions.
         (b)  A health maintenance organization that encourages an
  enrollee to obtain a health care service from a particular
  physician or provider, including offering incentives to encourage
  enrollees to use specific physicians or providers, or that
  introduces or modifies a tiered network plan or assigns physicians
  or providers into tiers, has a fiduciary duty to the enrollee or
  group contract holder to engage in that conduct only for the primary
  benefit of the enrollee or group contract holder.
         SECTION 2.  Section 1301.0045(a), Insurance Code, is amended
  to read as follows:
         (a)  Except as provided by Sections [Section] 1301.0046 and
  1301.0047, this chapter may not be construed to limit the level of
  reimbursement or the level of coverage, including deductibles,
  copayments, coinsurance, or other cost-sharing provisions, that
  are applicable to preferred providers or, for plans other than
  exclusive provider benefit plans, nonpreferred providers.
         SECTION 3.  Subchapter A, Chapter 1301, Insurance Code, is
  amended by adding Section 1301.0047 to read as follows:
         Sec. 1301.0047.  INCENTIVES TO USE CERTAIN PHYSICIANS OR
  HEALTH CARE PROVIDERS. (a)  An insurer may provide incentives for
  insureds to use certain physicians or health care providers through
  modified deductibles, copayments, coinsurance, or other
  cost-sharing provisions.
         (b)  An insurer that encourages an insured to obtain a health
  care service from a particular physician or health care provider,
  including offering incentives to encourage insureds to use specific
  physicians or providers, or that introduces or modifies a tiered
  network plan or assigns physicians or providers into tiers, has a
  fiduciary duty to the insured or policyholder to engage in that
  conduct only for the primary benefit of the insured or
  policyholder.
         SECTION 4.  This Act takes effect September 1, 2023.