HF 4152

Introduction - 94th Legislature (2025 - 2026)

Posted on 03/12/2026 03:08 p.m.

A bill for an act
relating to insurance; requiring health plans to credit enrollees for services provided
by an out-of-network provider at a lower cost than the plan's in-network providers;
authorizing commissioner of commerce enforcement; amending Minnesota Statutes
2024, sections 62J.81, subdivision 1a; 290.0132, by adding a subdivision; proposing
coding for new law in Minnesota Statutes, chapter 62J.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2024, section 62J.81, subdivision 1a, is amended to read:

Subd. 1a.

Required disclosure by health plan company.

(a) A health plan company,
as defined in section 62J.03, subdivision 10, shall, at the request of an enrollee intending
to receive specific health care services or the enrollee's designee, provide that enrollee with
a good faith estimate of new text begin :
new text end

new text begin (1) new text end the allowable amount the health plan company has contracted for with a specified
provider within the network as total payment for a health care service specified by the
enrollee and the portion of the allowable amount due from the enrollee and the enrollee's
out-of-pocket costs deleted text begin . deleted text end new text begin ; or
new text end

new text begin (2) the lowest allowable amount due from the enrollee as total payment for the health
care service for any provider, comparable to the out-of-network provider specified by the
enrollee for an out-of-network credit under section 62J.829 in (i) qualification to perform
the health care service and (ii) geographic accessibility, within the network.
new text end

An estimate provided to an enrollee under this paragraph is not a legally binding estimate
of the allowable amount or enrollee's out-of-pocket cost.

(b) The information required under this subdivision must be provided by the health plan
company to an enrollee within ten business days from the day a complete request was
received by the health plan company. For purposes of this section, "complete request"
includes all the patient and service information the health plan company requires to provide
a good faith estimate, including a completed good faith estimate form if required by the
health plan company.

Sec. 2.

new text begin [62J.829] COST-SHARING CREDIT FOR OUT-OF-NETWORK SERVICES.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the following terms have
the meanings given.
new text end

new text begin (b) "Estimated in-network cost difference" means the good faith estimate an enrollee
receives for a service from the health plan pursuant to section 62J.81, subdivision 1a,
paragraph (a), clause (2), minus the good faith estimate an enrollee receives for the service
from an out-of-network provider pursuant to section 62J.81, subdivision 1.
new text end

new text begin (c) "Out-of-network credit" means the credit required under subdivision 2.
new text end

new text begin Subd. 2. new text end

new text begin Required credit. new text end

new text begin (a) Subject to paragraph (d), all health plans must issue a
credit to an enrollee if the enrollee:
new text end

new text begin (1) received a health care service from a provider outside of the health plan's network;
and
new text end

new text begin (2) identified a positive estimated in-network cost difference for the health care service
from the out-of-network provider before receiving the service.
new text end

new text begin (b) Subject to paragraph (d), the credit required under paragraph (a) must be equal to
fifty percent of the estimated in-network cost difference. The health plan may require the
enrollee to provide reasonable documentation of the good faith estimates received from the
provider under section 62J.81, subdivision 1, before issuing the out-of-network credit. The
health plan is prohibited from conditioning the out-of-network credit on the health plan's
receipt of documentation of the good faith estimates before the enrollee receives the health
care service.
new text end

new text begin (c) Unless a request otherwise is made to the health plan by the enrollee or the enrollee's
designee, a health plan must apply an enrollee's out-of-network credit immediately, and
without any required action by the enrollee, as an offset against the enrollee's next due
payment obligation to the health plan until the enrollee has no available credit.
new text end

new text begin (d) The maximum aggregate amount of out-of-network credits an enrollee may have at
any time for a single health plan is $........ A health plan is not required to issue an
out-of-network credit if:
new text end

new text begin (1) the health care service is provided outside the United States; or
new text end

new text begin (2) the enrollee is delinquent on payment of premiums.
new text end

new text begin Subd. 3. new text end

new text begin Prohibition on limiting plan designs. new text end

new text begin A health plan must not impose any
cost-sharing requirement, utilization review limitation, or premium increase that limits an
enrollee's ability to receive, benefit from, or use an out-of-network credit. A premium
increase or cost-sharing increase directly or indirectly related to the amount of an enrollee's
out-of-network credit balance is considered a limit on an enrollee's ability to receive, benefit
from, or use an out-of-network credit. The prohibition under this subdivision applies to an
enrollee's existing plan, plan renewals, and health plan changes with the same health plan
company or the company's successor.
new text end

new text begin Subd. 4. new text end

new text begin Notice of credit balance. new text end

new text begin For each enrollee with a nonzero credit balance, a
health plan must provide a statement of the credit balance at least once every ... months.
The statement must clearly identify the enrollee's accruals and uses of out-of-network credits
within the past year and the currently available out-of-network credit balance.
new text end

new text begin Subd. 5. new text end

new text begin Credit payment upon plan termination. new text end

new text begin (a) Subject to paragraph (b), a health
plan must pay an amount equal to the available out-of-network credit balance to an enrollee
upon the cancellation, termination, expiration, or lapse of the health plan by the enrollee,
health plan, or law.
new text end

new text begin (b) A health plan is not required to make the payment under paragraph (a) if the health
plan is canceled, terminated, expired, or lapsed due to the enrollee's nonpayment of premiums,
material misrepresentation, or fraud.
new text end

new text begin Subd. 6. new text end

new text begin Application. new text end

new text begin If the application of this section before an enrollee has met their
health plan's deductible would result in: (1) health savings account ineligibility under United
States Code, title 26, section 223; or (2) catastrophic health plan ineligibility under United
States Code, title 42, section 18022(e), this section applies only after the enrollee has met
the enrollee's health plan's deductible.
new text end

new text begin Subd. 7. new text end

new text begin Enforcement. new text end

new text begin The commissioner of commerce may investigate and enforce
this section using any of the authority granted to the commissioner under section 45.027.
new text end

Sec. 3.

Minnesota Statutes 2024, section 290.0132, is amended by adding a subdivision
to read:

new text begin Subd. 40. new text end

new text begin Out-of-network credit balance. new text end

new text begin The amount of the out-of-network credit
balance paid to an enrollee under section 62J.829, subdivision 5, is a subtraction.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for taxable years beginning after December
31, 2025.
new text end