Bill > S698

This bill aims to modify consumer health insurance deductible calculations by introducing new definitions and requirements for insurers. The legislation defines several key terms, including "insurer" (health insurance issuers subject to state regulation), "cost sharing requirement" (copayments, coinsurance, deductibles), "enrollee" (individuals entitled to health care services), and "health care service" (medical items or services). The bill requires insurers to calculate an enrollee's cost sharing contributions by including all cost sharing amounts paid by the enrollee or on their behalf, ensuring that any financial assistance or reductions are fully applied towards the enrollee's out-of-pocket costs, deductibles, or similar obligations. When calculating the annual limitation on cost sharing, insurers must include expenditures for health care services covered by the enrollee's health plan and falling under essential health benefits categories. The provisions will apply to health plans entered into, amended, extended, or renewed on or after January 1, 2026, with the Commission authorized to develop implementing regulations. The primary goal of this legislation is to provide more transparency and potentially reduce out-of-pocket expenses for consumers by comprehensively accounting for their health care spending.

Business and Industry, Health and Social Services

https://malegislature.gov/Bills/194/S698