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