Bill > HF3123

This bill establishes new rules for how health insurance companies and pharmacy benefit managers (PBMs) must calculate an enrollee's contributions toward cost-sharing and out-of-pocket maximum requirements. Specifically, when determining an enrollee's progress toward their cost-sharing or out-of-pocket maximum, the bill requires health plans to include any amount paid by the enrollee or paid on their behalf by another person, including for prescription drugs covered under medical or pharmacy benefits. The bill defines cost-sharing as co-pays, coinsurance, and deductibles, and includes a provision that if applying these new calculation rules before meeting a plan's deductible would impact health savings account or catastrophic health plan eligibility, the new calculation method will only apply after the deductible is met. The bill is set to take effect on January 1, 2026, and will apply to health plans offered, issued, or renewed on or after that date, potentially providing more transparency and potentially lower out-of-pocket costs for enrollees by allowing third-party payments to count toward their cost-sharing requirements.

Business and Industry

https://www.revisor.mn.gov/bills/bill.php?b=House&f=HF3123&ssn=0&y=2025