Prohibited Conduct

Sec. 1366.057. PROHIBITED CONDUCT. An issuer of a health benefit plan may not: (1) modify the terms and conditions of coverage based on a request by an enrollee for less than the minimum coverage required under Section 1366.055(a); (2) offer to a woman who has given birth to a child a financial incentive or other compensation the receipt of which is contingent on the waiver by the woman of the minimum coverage required under Section 1366.055(a); (3) refuse to accept a physician's recommendation for inpatient care made in consultation with the woman who has given birth to a child if the period of inpatient care recommended by the physician does not exceed the minimum periods recommended in guidelines for perinatal care developed by: (A) the American College of Obstetricians and Gynecologists; (B) the American Academy of Pediatrics; or (C) another nationally recognized professional association of obstetricians and gynecologists or of pediatricians; (4) reduce payments or other forms of reimbursement for inpatient care below the usual and customary rate of reimbursement for that care; or (5) penalize a physician for recommending inpatient care for a woman or the woman's newborn child by: (A) refusing to permit the physician to participate as a provider in the health benefit plan; (B) reducing payments made to the physician; (C) requiring the physician to: (i) provide additional documentation; or (ii) undergo additional utilization review; or (D) imposing other analogous sanctions or disincentives. Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.