TX SB926

Health maintenance organizations and insurers may offer incentives (modified deductibles, copayments, coinsurance) to encourage enrollees to use certain physicians or providers, but must do so with a fiduciary duty to act primarily for the benefit of the enrollee or policyholder

Insurers violate fiduciary duty if they steer patients to providers solely because the provider is controlled by or under common control with the insurer, or if they use tiered networks to limit medically necessary services or encourage lower quality care

Incentives cannot be based solely on cost and cannot impose higher cost-sharing for out-of-network emergency services than would apply for in-network services

Health benefit plan issuers ranking or classifying physicians into tiers must use standards developed by commissioner-designated organizations (national medical specialty societies or unbiased bona fide organizations) and disclose rankings to affected physicians at least 45 days before release

Issuers must provide physicians an easy-to-use process to identify discrepancies or false information in rankings, and the commissioner must prohibit issuers from using ranking systems for at least 12 months if a pattern of discrepancies, falsehoods, or violations is found

Takes effect September 1, 2025