Texas § IN.1357.005 - PROHIBITED CONDUCT

§ IN.1357.005. PROHIBITED CONDUCT

PROHIBITED CONDUCT. (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. Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.