LEGISLATIVE SERVICES AGENCY
OFFICE OF FISCAL AND MANAGEMENT ANALYSIS
FISCAL IMPACT STATEMENT
LS 7280 NOTE PREPARED: Jan 7, 2025
BILL NUMBER: HB 1252 BILL AMENDED:
SUBJECT: Limitation on Cost Sharing.
FIRST AUTHOR: Rep. Smaltz BILL STATUS: As Introduced
FIRST SPONSOR:
FUNDS AFFECTED: GENERAL IMPACT: State & Local
XDEDICATED
FEDERAL
Summary of Legislation: This bill requires an insurer, an administrator, and a pharmacy benefit manager
to apply the annual limitation on cost sharing set forth in the federal Patient Protection and Affordable Care
Act under 42 U.S.C. 18022(c)(1). It provides that an insurer, an administrator, and a pharmacy benefit
manager may not directly or indirectly set, alter, implement, or condition the terms of health insurance
coverage based in part or entirely on information about the availability or amount of financial or product
assistance available for a prescription drug.
This bill requires, before December 31 of each year, each insurer and administrator to certify to the Insurance
Commissioner that the insurer or administrator has fully and completely complied with the cost sharing
requirements during the previous calendar year.
Effective Date: January 1, 2026.
Explanation of State Expenditures: The bill’s requirements will increase workload for the Indiana
Department of Insurance (DOI) but should be able to be implemented using existing staffing and resources.
[The DOI is funded through a dedicated agency fund.]
Additional Information: The State Employee Health Plan already complies with requirements regarding the
annual limitations on cost sharing. In accordance with the Patient Protection and Affordable Care Act (ACA),
the Centers for Medicare and Medicaid Services issues the annual limitations on cost sharing. For CY 2025,
the out-of-pocket maximum is equal to $9,200 for self-only coverage and $18,400 for family coverage, while
CY 2026 amounts are equal to $10,150 for self-only coverage and $20,300 for family coverage.
Explanation of State Revenues:
Explanation of Local Expenditures: Local units of government who offer health insurance coverage for
employees through a non-ERISA plan will need to ensure their plan complies with ACA requirements
regarding the annual limitations on cost sharing.
HB 1252 1 Explanation of Local Revenues:
State Agencies Affected: Indiana Department of Insurance.
Local Agencies Affected: Local units of government with non-ERISA employee health plans.
Information Sources: CMS Guidance issued October 8, 2024,
https://www.cms.gov/files/document/2026-papi-parameters-guidance-2024-10-08.pdf.
Fiscal Analyst: Jason Barrett, 317-232-9809.
HB 1252 2