House Bill No. 1687 introduces new provisions regarding out-of-pocket expense credits for enrollees of governmental employee health benefit plans in Texas. The bill adds Chapter 1582 to the Insurance Code, which outlines the applicability of the chapter to various health benefit plans, including basic coverage plans and county employee group health benefits. It establishes that enrollees who make direct payments to physicians or health care providers for medically necessary services, without submitting a claim to their health plan, can receive credits toward their deductible and annual maximum out-of-pocket expenses, provided the payment is less than the average discounted rate for the service.

Additionally, the bill mandates that health benefit plan issuers or administrators create a procedure for enrollees to claim these credits and specify the necessary documentation to support such claims. Information regarding this process must be easily accessible on the issuer's or administrator's website. The provisions of this bill will take effect on September 1, 2025, and will apply to health benefit plans that are delivered, issued for delivery, or renewed on or after January 1, 2026.

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