HB 1687

AN ACT relating to out-of-pocket expense credits for payments made

House Bill • Oliverson | Dean

Filed

Bill introduced by legislator

Committee

Hearing

Passed Cmte

Calendar

Passed

Sent

Enrolled

Governor

Signed

Filed

Bill introduced by legislator

In Committee

Hearing Scheduled

Passed Committee

Floor Calendar

Passed Chamber

Sent to Other Chamber

Passed Both Chambers

Sent to Governor

Signed into Law

89th Regular Session

Jan 14, 2025 - Jun 2, 2025 • Session ended

Awaiting Committee Assignment

Bill filed, pending referral to House committee

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What This Bill Does

Requires health benefit plans for state and local government employees to provide out-of-pocket expense credits when enrollees pay directly to physicians or healthcare providers for medically necessary services. If an enrollee pays less than the plan's average discounted rate for a service and does not submit a claim, the plan must credit that payment toward the enrollee's deductible and annual out-of-pocket maximum expenses. Health benefit plan issuers must create an accessible online procedure for enrollees to claim these credits and specify the required documentation.

Subject Areas

State Employees Health Care Providers Insurance--Health & Accident PHYSICIANS

Bill Text

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
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
(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
(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.