Bill > A5934

Introduced Session

This bill requires health insurance carriers to offer a clear cost share plan for individual health benefits plans. A clear cost share plan is a plan design that includes a set of annual copayments, coinsurance, and deductibles for all or a designated subset of benefits within a health benefits plan. Under this bill, the commissioner of the Department of Banking and Insurance, in consultation with the board of directors of the Individual Health Coverage Program, will be required to develop a clear cost share plan for individual health benefits plans. When creating the share plan, the commissioner will take into consideration the following: (1) the ability of a health plan to conform to actuarial value ranges; (2) focusing consumer choice to make the process of selecting a health plan more transparent and quality-based; (3) limiting out-of-pocket costs that serve as a financial barrier to accessing high-value care; and (4) fostering quality improvement through the promotion of benefits with a high value and a focus on the consumer. The commissioner will also be required to develop at least one clear cost share plan for each tier of a health insurance plan designated as bronze, silver, and gold in accordance with the federal Patient Protection and Affordable Care Act. A carrier will be required make available any clear cost share plan that is developed by the commissioner from each metal tier in order to participate in the individual market. Once created, the commissioner will evaluate annually whether to revise, discontinue, or add any clear cost share plan for use by a carrier, which includes, but is not limited to, considering whether a deductible or copayment level should be changed to reflect medical inflation and actuarial values. A 60-day public comment period will also be provided as part of the evaluation process, and sufficient public notice will be provided as to the commencement of the comment period. Additionally, a carrier will be able to offer up to three health benefits plans that modify one or more parameters in a clear cost share plan created by the commissioner if the carrier submits, and the commissioner approves, an actuarial certification stating that the alternative share plan offers significant consumer benefits and will not result in an adverse selection for the consumer. The commissioner will also ensure that the exchange's website prioritizes unmodified clear cost share plans and that a comparison be available to display the similarities and differences in coverage between modified and unmodified clear cost share plans. Finally, the commissioner will require that plans offered on the exchange conform to standardized plan designs that provide for standardized cost-sharing for covered health services.

Committee Categories

John McKeon (D)*,  Anthony Verrelli (D)*, 

Introduced, Referred to Assembly Financial Institutions and Insurance Committee (on 06/24/2021)