bill requiring HMO and PPO on insurance cards

The text as introduced · 431 words

89R2890 MEW-D

By: Lalani
H.B. No. 428

A BILL TO BE ENTITLED

AN ACT

relating to identification cards issued by health maintenance

organizations and preferred provider organizations.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Section 843.209, Insurance Code, is amended to

read as follows:

Sec. 843.209. IDENTIFICATION CARD. (a) An identification

card or other similar document issued by a health maintenance

organization to an enrollee must:

(1) indicate that the health maintenance organization

is regulated under this code and subject to the provisions of

Subchapter J; [ and ]

(2) display:

(A) the first date on which the enrollee became

enrolled; or

(B) a toll-free number a physician or provider

may use to obtain that date ; and

(3) display the acronym "HMO" in the location of the

health maintenance organization's choice .

(b) An identification card or other similar document that

bears the acronym "HMO" as required by Subsection (a) indicates

that health benefit coverage for health care services provided by a

participating physician or provider does not ensure the enrollee

has access to:

(1) health care services at a discounted rate if the

services are provided by a physician or provider who is not included

in the health maintenance organization delivery network; or

(2) other fee discounts available under the health

maintenance organization delivery network.

SECTION 2. Section 1301.162, Insurance Code, is amended to

read as follows:

Sec. 1301.162. IDENTIFICATION CARD. (a) An identification

card or other similar document issued by an insurer regulated by

this code and subject to this chapter to an individual insured must :

(1) display:

(A) [ (1) ] the first date on which the individual

became insured under the plan; or

(B) [ (2) ] a toll-free number a physician or

health care provider may use to obtain that date ; and

(2) display the acronym "PPO" in the location of the

insurer's choice .

(b) An identification card or other similar document that

bears the acronym "PPO" as required by Subsection (a) indicates

that health benefit coverage for medical care or health care

services provided by a preferred provider does not ensure the

insured has access to:

(1) medical care or health care services at a

discounted rate if the services are provided by an out-of-network

provider; or

(2) other fee discounts available under the provider

network.

SECTION 3. Sections 843.209 and 1301.162, Insurance Code,

as amended by this Act, apply only to an identification card or

other similar document issued on or after January 1, 2026.

SECTION 4. This Act takes effect September 1, 2025.