TX HB4681

Requires health maintenance organizations (HMOs) and insurers to provide written explanations of benefits in plain language, including clear descriptions of services received and any identifying or denial codes used

Mandates that preauthorization requirements be displayed prominently on insurer homepages, available free without login requirements, digitally searchable, and accessible to internet search engines

Expands required preauthorization statistics to include initial denials, expedited request approvals/denials, and average/median decision times, with denial reasons prohibited from being in alphanumeric code format

Increases notice period for new or amended preauthorization requirements to 60 business days (from 60 days), requiring written notice to all affected enrollees and network providers with specific effective dates and times

Establishes tiered administrative penalties for violations based on insurer gross revenue: up to $10/violation for under $10 million revenue, $100 for $10-100 million, and $1,000 for $100 million or more, with each day of violation counted separately; effective January 1, 2026