HB1687 - Relating to out-of-pocket expense credits for payments made directly to a physician or health care provider by an enrollee of a governmental employee health benefit plan.

  89R5018 DNC-D     By: Oliverson, Dean H.B. No. 1687       A BILL TO BE ENTITLED   AN ACT   relating to out-of-pocket expense credits for payments made   directly to a physician or health care provider by an enrollee of a   governmental employee health benefit plan.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Subtitle H, Title 8, Insurance Code, is amended   by adding Chapter 1582 to read as follows:   CHAPTER 1582.   PROVISIONS APPLICABLE TO STATE AND LOCAL EMPLOYEE   HEALTH BENEFITS   SUBCHAPTER A.   GENERAL PROVISIONS           Sec.   1582.001.     APPLICABILITY OF CHAPTER. This chapter   applies only to a health benefit plan that is:                 (1)  a basic coverage plan under Chapter 1551;                 (2)  a basic plan under Chapter 1575;                 (3)  a primary care coverage plan under Chapter 1579;                 (4)     a plan providing basic coverage under Chapter   1601;                 (5)     county employee group health benefits provided   under Chapter 157, Local Government Code; or                 (6)     health and accident coverage provided by a risk   pool created under Chapter 172, Local Government Code.   SUBCHAPTER B.   OUT-OF-POCKET EXPENSES           Sec.   1582.051.     OUT-OF-POCKET EXPENSE CREDIT.   (a)   The   issuer or administrator of a health benefit plan to which this   chapter applies shall credit toward an enrollee's deductible and   annual maximum out-of-pocket expenses an amount the enrollee pays   directly to any physician or health care provider for a medically   necessary covered medical or health care service or supply if a   claim for the service or supply is not submitted to the issuer or   administrator and the amount paid by the enrollee to the physician   or health care provider is less than the average discounted rate for   the service or supply paid to an equivalently licensed or   authorized preferred provider under the enrollee's health benefit   plan.           (b)  The health benefit plan issuer or administrator shall:                 (1)     establish a procedure by which an enrollee may   claim a credit under Subsection (a); and                 (2)     identify documentation necessary to support a   claim for a credit under Subsection (a).           (c)     Information about the procedure and documentation   described by Subsection (b) must be readily accessible to an   enrollee on the issuer's or administrator's Internet website.          SECTION 2.  The changes in law made by this Act apply only to   a health benefit plan delivered, issued for delivery, or renewed,   or a plan year that commences, on or after January 1, 2026.          SECTION 3.  This Act takes affect September 1, 2025.