bill counting cash paid to doctors toward government plan deductibles

The text as introduced · 389 words

89R5018 DNC-D

By: Oliverson
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.