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89(R) HB 1687 - House Committee Report version - Bill Text
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.