Massachusetts 2025-2026 Regular Session

Massachusetts Senate Bill S698 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. 1704 FILED ON: 1/16/2025
3	3	SENATE . . . . . . . . . . . . . . No. 698
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 EssexDylan A. FernandesPlymouth and Barnstable2/28/2025 1 of 3
16	16	SENATE DOCKET, NO. 1704 FILED ON: 1/16/2025
17	17	SENATE . . . . . . . . . . . . . . No. 698
18	18	By Mr. Crighton, a petition (accompanied by bill, Senate, No. 698) of Brendan P. Crighton and
19	19	Dylan A. Fernandes for legislation relative to consumer deductibles. Financial Services.
20	20	[SIMILAR MATTER FILED IN PREVIOUS SESSION
21	21	SEE SENATE, NO. 609 OF 2023-2024.]
22	22	The Commonwealth of Massachusetts
23	23	_______________
24	24	In the One Hundred and Ninety-Fourth General Court
25	25	(2025-2026)
26	26	_______________
27	27	An Act relative to consumer deductibles.
28	28	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
29	29	of the same, as follows:
30	30	1 Chapter 176O of the General Laws, as appearing in the 2022 Official Edition, is hereby
31	31	2amended by inserting after section 27 the following section:-
32	32	3 Section 28. (a) In this Section, the following terms shall have the following meanings:
33	33	4 “Insurer” means any health insurance issuer that is subject to state law regulating
34	34	5insurance and offers health insurance coverage, as defined in 42 U.S.C. § 300gg-91, or any state
35	35	6or local governmental employer plan.
36	36	7 “Cost sharing requirement” means any copayment, coinsurance, deductible, or annual
37	37	8limitation on cost sharing (including but not limited to a limitation subject to 42 U.S.C. §§
38	38	918022(c) and 300gg-6(b)), required by or on behalf of an enrollee in order to receive a specific
39	39	10health care service, including a prescription drug, covered by a health plan. 2 of 3
40	40	11 “Enrollee” means any individual entitled to health care services from an insurer.
41	41	12 “Health plan” means a policy, contract, certification, or agreement offered or issued by an
42	42	13insurer to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care
43	43	14services.
44	44	15 “Health care service” means an item or service furnished to any individual for the
45	45	16purpose of preventing, alleviating, curing, or healing human illness, injury or physical disability.
46	46	17 “Person” means a natural person, corporation, mutual company, unincorporated
47	47	18association, partnership, joint venture, limited liability company, trust, estate, foundation, not-
48	48	19for-profit corporation, unincorporated organization, government or governmental subdivision or
49	49	20agency.
50	50	21 (b) When calculating an enrollee’s contribution to any applicable cost sharing
51	51	22requirement, an insurer shall include any cost sharing amounts paid by the enrollee or on behalf
52	52	23of the enrollee by another person. Any cost sharing or reductions made for an enrollee’s benefit
53	53	24or towards an enrollee’s applicable cost sharing requirement shall be applied in full at the time it
54	54	25is rendered and wholly towards the enrollee’s out-of-pocket costs, deductible, cost sharing or
55	55	26similar enrollee obligation.
56	56	27 (c) When calculating an enrollee’s contribution to the annual limitation on cost sharing
57	57	28set forth in 42 U.S.C. §§ 18022(c) and 300gg-6(b), an insurer shall include expenditures for any
58	58	29health care service covered by the enrollee’s health plan and included within a category of
59	59	30essential health benefits as described in 42 U.S.C. § 18022(b)(1). 3 of 3
60	60	31 This section shall apply with respect to health plans that are entered into, amended,
61	61	32extended, or renewed on or after January 1, 2026.
62	62	33 The Commission may promulgate such rules and regulations as it may deem necessary to
63	63	34implement this section.