Bill > H4333

This bill introduces new regulations for health insurers regarding how they calculate consumer cost-sharing requirements, such as deductibles, copayments, and coinsurance. The bill defines several key terms, including "insurer" (any health insurance issuer subject to state regulation), "enrollee" (an individual entitled to health care services), and "health care service" (an item or service intended to prevent, alleviate, or heal illness or disability). The legislation requires insurers to include all cost-sharing amounts paid by or on behalf of an enrollee when calculating their contribution to cost-sharing requirements, ensuring that any cost-sharing reductions or payments are fully applied towards the enrollee's out-of-pocket costs or deductible. The bill includes a specific provision for health savings account-qualified high-deductible health plans to maintain compliance with federal tax regulations, with special considerations for preventive care. The new rules will apply to health plans entered into, amended, extended, or renewed on or after January 1, 2026, and the Commission is authorized to create necessary implementation regulations. The overall aim is to provide more transparency and potentially reduce out-of-pocket expenses for consumers by comprehensively accounting for all cost-sharing contributions.

Health and Social Services

Joint Committee on Financial Services (Joint)

https://malegislature.gov/Bills/194/H4333