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SENATE DOCKET, NO. 1858 FILED ON: 1/20/2023
SENATE . . . . . . . . . . . . . . No. 776
The Commonwealth of Massachusetts
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PRESENTED BY:
Paul W. Mark
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To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:
The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
An Act limiting out of pocket expenses.
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PETITION OF:
NAME:DISTRICT/ADDRESS :Paul W. MarkBerkshire, Hampden, Franklin and
Hampshire 1 of 2
SENATE DOCKET, NO. 1858 FILED ON: 1/20/2023
SENATE . . . . . . . . . . . . . . No. 776
By Mr. Mark, a petition (accompanied by bill, Senate, No. 776) of Paul W. Mark for legislation
to limit out of pocket expenses. Health Care Financing.
[SIMILAR MATTER FILED IN PREVIOUS SESSION
SEE HOUSE, NO. 1295 OF 2021-2022.]
The Commonwealth of Massachusetts
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In the One Hundred and Ninety-Third General Court
(2023-2024)
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An Act limiting out of pocket expenses.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
of the same, as follows:
1 SECTION 1. Section 6 of chapter 32A of the General Laws is hereby amended by
2inserting after the fourth sentence thereof the following new sentence: -
3 For active and retired employees, their dependents and the survivors of deceased
4employees, including municipal subscribers, the maximum amount of deductibles and
5copayments for covered services during an enrollment year in a plan shall not exceed $2,500 for
6individual coverage and $5,000 for family coverage.
7 SECTION 2. Subsection (b) Section 22 of Chapter 32B is hereby amended by striking the
8first paragraph and inserting the following new paragraph:-
9 (b) An appropriate public authority may increase the dollar amounts for copayments,
10deductibles, tiered provider network copayments and other cost-sharing plan design features; 2 of 2
11provided that, for subscribers enrolled in a non-Medicare plan, such features do not exceed plan
12design features offered by the commission pursuant to section 4 or 4A of chapter 32A in a non-
13Medicare plan with the largest subscriber enrollment and, for subscribers enrolled in a Medicare
14plan under section 18A, such features do not exceed plan design features offered by the
15commission pursuant to section 4 or 4A of chapter 32A in a Medicare plan with the largest
16subscriber enrollment; provided that for active and retired employees, their dependents and the
17survivors of deceased employees the maximum amount of health insurance deductibles and
18copayments for covered services during an enrollment year in a plan shall not exceed those
19offered by the commission; provided, however, that the public authority need only satisfy the
20requirements of subsection (a) of section 21 the first time changes are implemented pursuant to
21this section; and provided, further that the public authority meet its obligations under subsections
22(b) to (h), inclusive, of section 21 each time an increase to a plan design feature is proposed.
23 SECTION 3. Section 9 of Chapter 32A is hereby amended by inserting the following new
24paragraph at the end thereof:-
25 Any and all excess premium payments made by the Commonwealth and or its employees
26and retirees shall remain in the trust fund, to be utilized for the purposes of paying the out of
27pocket expenses in excess of the limitations established in Section 6 up to the combined medical
28and pharmaceutical maximums established pursuant to the Patient Protection and Affordable
29Care Act , 42 U.S.C. ยง18001 et seq. (2010) or improving insurance benefits for its employees
30and retirees. Premium payments pursuant to this section shall include sums appropriated by the
31General Court or paid by the insured for self-insured products offered by the group insurance
32commission.