HF 3123

as introduced - 94th Legislature (2025 - 2026) Posted on 04/07/2025 03:06pm

A bill for an act
relating to health insurance; setting requirements for the calculation of an enrollee's
contribution toward cost-sharing and out-of-pocket maximum requirements;
proposing coding for new law in Minnesota Statutes, chapter 62Q.

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

Section 1.

new text begin [62Q.491] COST-SHARING OR OUT-OF-POCKET MAXIMUM
REQUIREMENTS; ENROLLEE CONTRIBUTION.
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) "Cost-sharing" means co-pays, coinsurance, and deductibles.
new text end

new text begin (c) "Pharmacy benefit manager" has the meaning given in section 62W.02, subdivision
15.
new text end

new text begin Subd. 2. new text end

new text begin Calculation. new text end

new text begin (a) When calculating an enrollee's overall contribution to a
cost-sharing or out-of-pocket maximum requirement, a health plan company or pharmacy
benefit manger must include any amount paid by an enrollee or paid on behalf of an enrollee
by another person. The requirement under this paragraph applies to prescription drugs
approved for coverage by the health plan company, whether the prescription drugs are
covered under a medical or pharmacy benefit.
new text end

new text begin (b) If application of this section before an enrollee has met the enrollee's plan deductible
results 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 to calculations only after the enrollee has met the enrollee's
plan deductible.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2026, and applies to health
plans offered, issued, or renewed on or after that date.
new text end