Bill > H1101

This bill introduces new provisions to Chapter 176O of Massachusetts General Laws regarding how health insurers calculate and apply cost-sharing requirements for enrollees. The bill defines several key terms, including "insurer" (any health insurance issuer subject to state regulation), "cost sharing requirement" (copayments, coinsurance, deductibles, or annual cost-sharing limitations), and "enrollee" (an individual entitled to health care services). The legislation mandates that when calculating an enrollee's contribution to cost-sharing requirements, insurers must include all cost-sharing amounts paid by the enrollee or on behalf of the enrollee by another person. Additionally, any cost-sharing reductions must be fully applied at the time of service and count towards the enrollee's out-of-pocket costs or deductible. The bill also specifies that when calculating the annual limitation on cost sharing, insurers must include expenditures for health care services covered by the enrollee's health plan and within essential health benefits categories. These new requirements will apply to health plans entered into, amended, extended, or renewed on or after January 1, 2026, with the regulatory commission empowered to create necessary implementation rules.

Business and Industry

https://malegislature.gov/Bills/194/H1101