Insurance

SB 815 requires health insurers and health maintenance organizations (HMOs) to disclose in written explanations of benefits whether artificial intelligence (AI) was used in processing claims or making coverage decisions. If AI was used, the disclosure must include a plain-language description of how the AI system operated. The bill directly affects insurers/HMOs by mandating these transparency requirements for patients and healthcare providers, specifically addressing "adverse determinations" like denied coverage. It does not restrict AI use but ensures consumers and doctors understand when automated systems influence their health benefit decisions.

SB 493 protects pharmacists and pharmacies from contractual restrictions that prevent them from sharing key cost information with patients and discussing service details with health insurance plans. Specifically, it prohibits contracts from blocking pharmacists from: (1) informing patients about differences between their out-of-pocket costs with and without submitting a claim under their health plan, and (2) communicating with insurers about prescription drug benefits, pharmacy services, network access, or reimbursement. The law applies only to contracts entered into or amended on or after September 1, 2025, directly affecting pharmacists, pharmacies, and patients covered by health benefit plans. It creates a clear legal right for pharmacists to discuss cost and service matters without penalty.

SB 2544 creates a mandatory mediation process for disputes over out-of-network health care billing between providers and insurance companies. It requires that requests for mediation must be filed within 90 days of an initial payment for services provided on or after the bill's effective date (June 20, 2025). For disputes involving services provided before this date, mediation eligibility is limited to requests made within 120 days of the effective date under the previous law. The bill applies only to new disputes after its effective date, with no impact on pre-existing disputes that miss the 120-day window.

SB 926 regulates how health insurance plans (health maintenance organizations) can incentivize patients to use specific doctors. It allows plans to use modified deductibles, copayments, or tiered networks to encourage enrollment with certain providers, but requires them to act in the patient's best interest (a "fiduciary duty"). The bill prohibits plans from steering patients toward doctors they control or are affiliated with, mandates that recommended providers meet quality standards, and bans misleading claims about provider quality or costs. These rules apply directly to health insurers and their enrollees (patients) in Texas, effective September 1, 2025.

SB 1644 requires insurers in Texas to provide consumers with specific notices when credit scores affect their home or auto insurance underwriting or pricing. It mandates that insurers give written notice within 30 days explaining adverse credit-based decisions, including how to access their credit report and dispute inaccuracies. The bill also requires insurers to use credit reports no older than 90 days for new policies and update them at least every 36 months, with consumers able to request a re-rating based on a current report. This law directly affects Texas residents applying for or renewing personal property/casualty insurance policies.