HF3123

Purpose of the Bill

The purpose of the bill is to regulate how health insurance companies in Minnesota calculate an enrollee's contribution toward cost-sharing and out-of-pocket maximums. It aims to make these calculations more inclusive by considering all payment contributions made by or on behalf of the enrollee.

Main Provisions

• The bill requires health insurance companies and pharmacy benefit managers to account for any amounts paid by enrollees or on their behalf when calculating the enrollee's total contribution towards cost-sharing (copays, coinsurance, and deductibles) and out-of-pocket maximums.
• This calculation applies whether the payments are for prescription drugs covered under either medical or pharmacy benefits provided by the health plan.

Significant Changes

• Currently, health plans may not include payments made on behalf of enrollees when calculating cost-sharing amounts. This bill mandates the inclusion of these payments.
• If following this new calculation method affects an enrollee's eligibility for a health savings account (HSA) or a catastrophic health plan, the new method is applied only after the enrollee has met their deductible, preserving their eligibility.

Relevant Terms

cost-sharing, out-of-pocket maximum, health insurance, enrollee contribution, copays, coinsurance, deductibles, pharmacy benefit manager, prescription drugs, health savings account (HSA), catastrophic health plan.