Bill > HB5099

This bill establishes a shared savings program for certain managed care health benefit plans in Texas, requiring health plan issuers to create a system that enables enrollees to save money on out-of-network healthcare services. Under the program, enrollees can request the average contracted rate for a specific healthcare service and obtain a cost estimate from out-of-network providers. If an enrollee receives a service that costs less than the disclosed rate, they are eligible to receive 50% of the difference (minus deductibles and copayments), provided the savings are at least $50. The bill applies to health maintenance organizations, preferred provider benefit plans, and basic coverage plans, and mandates that health plan issuers provide a toll-free number and website where enrollees can request rate information. Additionally, if an out-of-network service ends up costing more than the initial estimate due to unforeseen circumstances, the health plan will cover 95% of the additional cost. The program will apply to health benefit plans delivered, issued, or renewed on or after January 1, 2026, with the act taking effect on September 1, 2025, aiming to increase transparency and provide financial incentives for patients seeking cost-effective healthcare services.

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https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=HB5099