TX HB1687

Requires issuers and administrators of governmental employee health benefit plans to credit direct payments made by enrollees to physicians or health care providers toward the enrollee's deductible and annual maximum out-of-pocket expenses

Credits apply only when no claim is submitted to the insurer and the amount paid is less than the average discounted rate the plan pays to preferred providers for the same service

Applies to state employee plans (Chapter 1551), teacher retirement plans (Chapter 1575), school employee plans (Chapter 1579), university employee plans (Chapter 1601), county employee group benefits, and local government risk pool health coverage

Health benefit plan issuers and administrators must establish procedures for enrollees to claim credits and identify required documentation, with this information made readily accessible on their websites

Takes effect September 1, 2025, applying to health benefit plans delivered, issued, renewed, or plan years commencing on or after January 1, 2026