Tex. Insurance Code § 1357.005
This is the official text of Tex. Insurance Code § 1357.005, part of Texas’s Insurance Code — regulates insurance companies and the policies they sell.
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§ 1357.005. PROHIBITED CONDUCT.
Official statutory text
(a) An issuer of a health benefit plan may not:
(1) offer a financial incentive for an enrollee to not receive breast reconstruction or to waive the coverage required under this subchapter;
(2) condition, limit, or deny the eligibility of a person to enroll in the plan or to renew coverage under the terms of the plan solely to avoid the requirements of this subchapter; or
(3) reduce or limit the reimbursement or amount paid to, or otherwise penalize, an attending physician or provider or provide a financial incentive or other benefit to an attending physician or provider to induce the physician or provider to provide care to an enrollee in a manner that is inconsistent with this subchapter.
(b) This section does not prevent an issuer of a health benefit plan from negotiating with a physician or provider the level and type of reimbursement that the physician or provider will receive for care provided in accordance with this subchapter.
(1) offer a financial incentive for an enrollee to not receive breast reconstruction or to waive the coverage required under this subchapter;
(2) condition, limit, or deny the eligibility of a person to enroll in the plan or to renew coverage under the terms of the plan solely to avoid the requirements of this subchapter; or
(3) reduce or limit the reimbursement or amount paid to, or otherwise penalize, an attending physician or provider or provide a financial incentive or other benefit to an attending physician or provider to induce the physician or provider to provide care to an enrollee in a manner that is inconsistent with this subchapter.
(b) This section does not prevent an issuer of a health benefit plan from negotiating with a physician or provider the level and type of reimbursement that the physician or provider will receive for care provided in accordance with this subchapter.
Status: in_force · Read it on the official government site
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