Bill > LB158

This bill establishes new requirements for health carriers and pharmacy benefit managers (PBMs) regarding how out-of-pocket maximums and cost-sharing are calculated for health benefit plans. Specifically, the bill mandates that starting January 1, 2026, health carriers and PBMs must include any amount paid by a health plan enrollee or paid on their behalf by another person when calculating the enrollee's overall contribution to out-of-pocket maximums or cost-sharing requirements. The bill provides definitions for key terms like "cost-sharing requirement" (which includes copayments, deductibles, and annual cost-sharing limits), "health benefit plan" (an insurance policy or contract), and "health carrier" (as defined in existing state law). There is a special provision for health savings accounts (HSAs): if including these payments would make an HSA ineligible under federal tax law, the requirement only applies after the enrollee has met the minimum deductible, with an exception for preventive care services, which must be counted regardless of the deductible status. The goal of the bill appears to be providing more transparency and potentially reducing out-of-pocket costs for health plan enrollees by broadening what can be counted towards their annual spending limits.

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https://nebraskalegislature.gov/bills/view_bill.php?DocumentID=58750