House Bill No. 1687 introduces new provisions under Chapter 1582 of the Insurance Code, specifically aimed at enhancing the out-of-pocket expense credits for enrollees of governmental employee health benefit plans. The bill mandates that health benefit plan issuers or administrators must credit amounts paid directly by enrollees to physicians or health care providers for medically necessary services, provided that these payments are less than the average discounted rate for similar services. This credit will apply only if a claim for the service is not submitted to the issuer or administrator. Additionally, the bill requires the establishment of a procedure for enrollees to claim these credits and mandates that necessary documentation be identified and made readily accessible on the issuer's or administrator's website.

The provisions outlined in this bill will only apply to health benefit plans that are delivered, issued for delivery, or renewed on or after January 1, 2026, and the act is set to take effect on September 1, 2025. This legislation aims to provide financial relief to enrollees by ensuring that their direct payments to health care providers are recognized and credited towards their deductibles and out-of-pocket maximums.

Statutes affected:
Introduced: ()
House Committee Report: ()