Relating to a uniform coordination of benefits questionnaire for health benefit plans.
ModeratePlan for compliance
Low Cost
Effective:2025-06-20
Enforcing Agencies
Texas Department of Insurance
01
Compliance Analysis
Key implementation requirements and action items for compliance with this legislation
Implementation Timeline
Effective Date: June 20, 2025 (Legal enactment).
Compliance Deadline:February 1, 2026. (Hard deadline: The new uniform questionnaire must be used for all COB activities on or after this date).
Agency Rulemaking: The Texas Department of Insurance (TDI) is statutorily required to adopt rules and publish the final questionnaire by January 1, 2026.
*Warning:* This creates a dangerous 30-day "sprint" window between the finalization of the form and the mandatory implementation date.
Immediate Action Plan
1.Audit Current Workflows: Identify every touchpoint where a COB inquiry is currently triggered and inventory the data fields you currently collect.
2.Notify IT Vendors: Alert your internal IT or external software vendors immediately that a mandatory system update will be required in January 2026 with a non-negotiable February 1 go-live.
3.Engage in Rulemaking: Assign a representative to monitor TDI stakeholder meetings in late 2025 to influence the design of the form so it remains operationally viable for your adjudication logic.
4.Freeze Form Stock: Stop ordering or printing bulk stock of current proprietary COB forms to avoid waste.
Operational Changes Required
Contracts
TPA/ASO Agreements: Review Master Services Agreements with Third-Party Administrators immediately. Ensure they are contractually obligated to implement state-mandated form changes by the statutory deadline without passing "custom programming" costs to the plan sponsor.
Provider Agreements: Update provider manuals to reference the new Uniform COB Questionnaire as the sole acceptable instrument for COB inquiries.
Hiring/Training
Claims Adjudication Staff: Retrain intake teams to recognize and accept *only* the new state-mandated Uniform COB Questionnaire.
Customer Service: Equip support staff with scripts explaining that the change in forms is a state mandate, not a carrier policy change, to mitigate provider friction.
Reporting & Record-Keeping
Data Mapping: Internal claims systems must be re-mapped to ingest the specific data points defined in the forthcoming TDI rules.
Audit Trails: You must maintain documentation proving that the uniform questionnaire—and not a legacy proprietary form—was the instrument used for any COB determination made on or after February 1, 2026.
Fees & Costs
IT Development: Budget for Q4 2025 and Q1 2026 IT spend to update provider portals, downloadable form libraries, and data ingestion triggers.
No State Fees: There are no new filing fees associated with this legislation.
Strategic Ambiguities & Considerations
The legislation leaves specific operational details to TDI rulemaking. Watch for the following during the stakeholder process:
1.Digital Equivalence: The law mandates a "questionnaire" but does not explicitly validate web-based forms vs. static PDFs. We must verify if a digital intake flow mirroring the questions satisfies the requirement.
2."Made Available": The statute requires you to make the form available to providers. Rulemaking will define if a website link is sufficient or if active distribution is required.
3.Supplemental Questions: It is currently unclear if carriers can ask *additional* questions alongside the uniform form, or if the state form is the *exclusive* data gathering tool. Assume the latter until clarified.
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Information presented is for general knowledge only and is provided without warranty, express or implied. Consult qualified government affairs professionals and legal counsel before making compliance decisions.
The author has informed the committee that many of the major health insurance carriers in Texas have unique questionnaires asking for the same or similar information with respect to the coordination of benefits for patients covered under dual plans, and that the need to coordinate the forms of different carriers can cause errors resulting in patients receiving a surprise bill. H.B. 388 seeks to prevent such errors and help expedite the coordination of benefits process by requiring the Texas Department of Insurance to establish a uniform coordination of benefits questionnaire to be used by health benefit plan issuers in Texas.
CRIMINAL JUSTICE IMPACT
It is the committee's opinion that this bill does not expressly create a criminal offense, increase the punishment for an existing criminal offense or category of offenses, or change the eligibility of a person for community supervision, parole, or mandatory supervision.
RULEMAKING AUTHORITY
It is the committee's opinion that rulemaking authority is expressly granted to the commissioner of insurance in SECTION 1 of this bill.
ANALYSIS
H.B. 388 amends the Insurance Code to require the commissioner of insurance, in collaboration with appropriate stakeholders and not later than January 1, 2026, to adopt rules establishing a uniform coordination of benefits questionnaire to be used by all health benefit plan issuers in Texas. The bill requires each health benefit plan issuer that issues a health benefit plan that includes a coordination of benefits provision to use the questionnaire and make the questionnaire available to health care providers as appropriate. The bill specifies the types of plans to which its provisions apply. The bill applies only to the use of a coordination of benefits questionnaire on or after February 1, 2026.
Honorable Jay Dean, Chair, House Committee on Insurance
FROM:
Jerry McGinty, Director, Legislative Budget Board
IN RE:
HB388 by Harris Davila (Relating to a uniform coordination of benefits questionnaire for health benefit plans.), As Introduced
No significant fiscal implication to the State is anticipated.
It is assumed that any costs associated with the bill could be absorbed using existing resources.
Local Government Impact
No significant fiscal implication to units of local government is anticipated.
Source Agencies:
323 Teacher Retirement System, 327 Employees Retirement System, 454 Department of Insurance, 529 Health and Human Services Commission, 710 Texas A&M University System Administrative and General Offices, 720 The University of Texas System Administration
LBB Staff:
JMc, AAL, BFa
Related Legislation
Explore more bills from this author and on related topics
Texas has mandated the standardization of the Coordination of Benefits (COB) process, effectively outlawing the use of proprietary carrier forms for health benefit plans, including those sponsored by Professional Employer Organizations (PEOs). All entities managing health claims must transition to a single, state-designed questionnaire by February 1, 2026, creating a critical operational pivot point for claims adjudication systems. Implementation Timeline Effective Date: June 20, 2025 (Legal enactment).
Q
Who authored HB388?
HB388 was authored by Texas Representative Caroline Harris Davila during the Regular Session.
Q
When was HB388 signed into law?
HB388 was signed into law by Governor Greg Abbott on June 20, 2025.
Q
Which agencies enforce HB388?
HB388 is enforced by Texas Department of Insurance.
Q
How urgent is compliance with HB388?
The compliance urgency for HB388 is rated as "moderate". Businesses and organizations should review the requirements and timeline to ensure timely compliance.
Q
What is the cost impact of HB388?
The cost impact of HB388 is estimated as "low". This may vary based on industry and implementation requirements.
Q
What topics does HB388 address?
HB388 addresses topics including insurance, insurance--health & accident, insurance, commissioner of and employee benefits & leave.
Legislative data provided by LegiScanLast updated: November 25, 2025
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