TX HB5099

Requires health maintenance organizations, preferred provider plans, and state employee basic coverage plans to establish shared savings programs for nonemergency health care services beginning January 1, 2026

Mandates insurers operate toll-free phone lines and websites where enrollees can request disclosure of the average contracted rate paid to in-network providers for specific services over the preceding 12 months

Requires out-of-network providers to give enrollees written estimates of final charges, including all costs and out-of-pocket expenses, upon request

Enrollees who obtain care at a cost below the disclosed average network rate receive 50% of the savings (minus deductibles, copays, and coinsurance), with payment due within 30 days of claim submission; no payment required if savings are less than $50

When enrollees use the program with qualifying lower-cost out-of-network providers, in-network deductible rates apply; if unforeseen circumstances cause final charges to exceed estimates, the insurer pays 95% of the difference up to the allowed amount