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.