Massachusetts 2023-2024 Regular Session

Massachusetts Senate Bill S609 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	1 of 1
2	2	SENATE DOCKET, NO. 1230 FILED ON: 1/19/2023
3	3	SENATE . . . . . . . . . . . . . . No. 609
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	Brendan P. Crighton
8	8	_________________
9	9	To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
10	10	Court assembled:
11	11	The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
12	12	An Act relative to consumer deductibles.
13	13	_______________
14	14	PETITION OF:
15	15	NAME:DISTRICT/ADDRESS :Brendan P. CrightonThird Essex 1 of 3
16	16	SENATE DOCKET, NO. 1230 FILED ON: 1/19/2023
17	17	SENATE . . . . . . . . . . . . . . No. 609
18	18	By Mr. Crighton, a petition (accompanied by bill, Senate, No. 609) of Brendan P. Crighton for
19	19	legislation relative to consumer deductibles. Financial Services.
20	20	The Commonwealth of Massachusetts
21	21	_______________
22	22	In the One Hundred and Ninety-Third General Court
23	23	(2023-2024)
24	24	_______________
25	25	An Act relative to consumer deductibles.
26	26	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
27	27	of the same, as follows:
28	28	1 Chapter 176O of the General Laws, as appearing in the 2020 Official Edition, is hereby
29	29	2amended by inserting after section 27 the following section:-
30	30	3 Section 28. (a) In this Section, the following terms shall have the following meanings:
31	31	4 “Insurer” means any health insurance issuer that is subject to state law regulating
32	32	5insurance and offers health insurance coverage, as defined in 42 U.S.C. § 300gg-91, or any state
33	33	6or local governmental employer plan.
34	34	7 “Cost sharing requirement” means any copayment, coinsurance, deductible, or annual
35	35	8limitation on cost sharing (including but not limited to a limitation subject to 42 U.S.C. §§
36	36	918022(c) and 300gg-6(b)), required by or on behalf of an enrollee in order to receive a specific
37	37	10health care service, including a prescription drug, covered by a health plan.
38	38	11 “Enrollee” means any individual entitled to health care services from an insurer. 2 of 3
39	39	12 “Health plan” means a policy, contract, certification, or agreement offered or issued by an
40	40	13insurer to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care
41	41	14services.
42	42	15 “Health care service” means an item or service furnished to any individual for the
43	43	16purpose of preventing, alleviating, curing, or healing human illness, injury or physical disability.
44	44	17 “Person” means a natural person, corporation, mutual company, unincorporated
45	45	18association, partnership, joint venture, limited liability company, trust, estate, foundation, not-
46	46	19for-profit corporation, unincorporated organization, government or governmental subdivision or
47	47	20agency.
48	48	21 (b) When calculating an enrollee’s contribution to any applicable cost sharing
49	49	22requirement, an insurer shall include any cost sharing amounts paid by the enrollee or on behalf
50	50	23of the enrollee by another person. Any cost sharing or reductions made for an enrollee’s benefit
51	51	24or towards an enrollee’s applicable cost sharing requirement shall be applied in full at the time it
52	52	25is rendered and wholly towards the enrollee’s out-of-pocket costs, deductible, cost sharing or
53	53	26similar enrollee obligation.
54	54	27 (c) When calculating an enrollee’s contribution to the annual limitation on cost sharing
55	55	28set forth in 42 U.S.C. §§ 18022(c) and 300gg-6(b), an insurer shall include expenditures for any
56	56	29health care service covered by the enrollee’s health plan and included within a category of
57	57	30essential health benefits as described in 42 U.S.C. § 18022(b)(1).
58	58	31 This section shall apply with respect to health plans that are entered into, amended,
59	59	32extended, or renewed on or after January 1, 2024. 3 of 3
60	60	33 The Commission may promulgate such rules and regulations as it may deem necessary to
61	61	34implement this section.