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.
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