Legislative Blog
J.B. Williams, J.D.
7 bills that modify the Insurance
A Blog about 88th Legislature Laws
A Bit of Background
The following backgrounds help summarize the author's views on both the general topic: Texas and more specifically 88th Legislature Laws as it relates to that topic.
Brief Summary of Texas
Texas is truly a Republic. There are a multitude of items that to modify the state constitution must be modified. So there are times when Constitutional amendments are on the voting ballots. While I sometimes abhor the wording, the concept that all of those legally able to vote in Texas must vote on the change is a good one. And bills in Texas are generally short, making it easier for everyone to understand.
Summary of 88th Legislature Laws
The blogs here will discuss the laws passed by Congress and signed into law, as well as those, passed by Congress and approved by the voters to become law. There are a multitude of laws and each time I post blogs I will notate here the current effective date if it is different from prior blogs. I am currently posting bills that took effect immediately - those bills total 336. I am currently posting regarding larger bills, so each blog covers a single bill.
Blog Summary
HB 1040
HB 1074
HB 1337 - deals with serious mental illness medications
HB 1527
HB 1592
HB 1647 - deals with chronic, life-threatening clinician administered medications
HB 1696
7 bills that modify the Insurance
Published: 2025-12-11
Multiple short modifications
HB 1040 - 6 pages
Where insurance entities were previously required to provide written communications, they may not do so electronically. Rather than requiring your consent to electronic communications, the mere use of electronic communications is sufficient notice to you as long as there is a means of your request for written communications instead. There can be a means which you may request them and there may be associated costs.
HB 1074 - 3 pages
This relates to reasonableness of costs associated with loss control risks. I feel it is nearly impossible to show that there is discrimination in pricing insurance risks as they can always provide data to support their reasoning. But then I do believe that insurance if a complete pyramid scheme - they are betting that they pay out less than they take in and you are insuring against the smallest likelihood of something happening. It's all based upon how fearful they can make the public.
HB 1337 - 3 pages
This section applies to medications associated with serious mental illness, specifically bipolar disorders, depression in childhoood and adolescence, major depressive disorders, obsessive-compulsive disorders, paranoid and psychotic disorders, schizo-affective disorders, and schizophrenia. The patient must be 18 or older.
To treat a serious mental illness, the patient does not have to show that more than one other drug failed to successfully treat the issue or show a history of failure of one or more other drugs. A step therapy protocol may be implemented and may require a trial of the pharmaceutical as a condition to coverage only once in a plan year and if the drug is added to the plan's drug formulary.
HB 1527 - 8 pages
An employee benefit plan or health insurance policy can only request a refund of overpayment to a dentist if they request it in writing within 180 days and staet the specific reasons for the requested recovery of payments. The dentist may file a written objection within 45 days or object in accordance with procedures to exhaust all rights of appeal.
A policy may not limit with the dentist may charge for a service, and may not prohibit them from billing and collecting from the patient for services that are dental necessity.
Dentist can object to third party access associated with coverage under a plan, and cannot be removed merely because they object.
This seems like it is mostly going down the same path that medical insurance coverage originally traveled. Of course, medical insurance is now a complete disaster. So it appears that they will shove dental insurance coverage down the same path. The only true winners in this situation are the insurance companies.
HB 1592 - 2 pages
This applies dispute resolution to self-insurance or self-funded plans that an employer establishes for the benefit of the employees.
HB 1647 - 6 pages
This does not apply to a insurance policy for pharmacy benefits under state Medicaid, child health plan, TRICARE military health system, or workers' compensation insurance. It is applicable to medications provided to a patient that are generally not administered by a patient and are generally provided in a doctor's office.
For a patient that has complex, chronic, rare, or life-threatening medical conditions, insurance may not require clinician-administered drugs be dispensed by specific pharmacies; delay delivery only if it will not place the patient at increased health risk based upon the patient and physician's assessment; require additional fees based upon the choice of dispensing.
I understand the not feeing extra concept, however if the drug is readily available at 2 locations that are within a couple of miles and one is more expensive than the other, I would also understand the insurance not covering the higher priced location. Honestly patients currently have no reason to ever consider seeking care, medications, testing at a location that is less costly unless the additional cost is placed on them by the insurance company. To be honest though, if people paid up front and then requested their insurance reimburse them, people would pay more attention to the costs. This would permit costs to drop because medical entities would not have to have a bunch of people filing and re-filing claims and waiting months to receive payments. And insurance would have to be nicer to you because if they were not, then you could choose a different insurance entity.
HB 1696 - 15 pages
This basically provides that health insurance cannot require optometrist to recommend a specific location for a patient to get prescriptions filled, or may not recommend which optometrist a patient use based upon their affiliation with an entity which the insurance may co-own. It may not require an optometrist to provide services at a loss or pay different ones different rates for the same service. It may not require an optometrist to report a patient's prescription, ophthalmic device measurements, facial photo, or unique anatomical measurements as a condition to filing a claim.
Some of these things are a bit 'scary' if insurance was requiring them to be done to file claims in the past. As far as the same pay thing, I am certain the insurance can find a way to differentiate services to pay differing amounts.
I had no idea that EyeMed and VSP insurance owns frame manufacturers (like Ray-Ban, Nike), lens labs, and retail chains (LensCrafters, Target Optical, Sunglass Hut). Specifically EssilorLuxottica owns Lenscrafters, Pearle Vision, Sunglass Hut, EyeMed insurance, and Ray-Ban. While V owns Eyeconic and contracts with independent doctors. More amusing, if you buy from EyeBuyDirect you get wholesale pricing and they are partially owned by Luxottica. Of course, I do not carry eye insurance, so not an area I delve into that often.
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