Michigan House Bill HB4719

Michigan 2023-2024 Regular Session

• Introduced: 6/8/23
• Refer: 6/8/23

Caption

Insurance: health benefits; application of amount paid by the insured or other certain parties when calculating the insured’s co-pay for a prescription drug; require under certain conditions. Amends 1956 PA 218 (MCL 500.100 - 500.8302) by adding sec. 3406z.

Impact

The implications of HB 4719 are significant for both consumers and insurance providers. By ensuring that all payments made toward prescription drugs count towards the out-of-pocket maximums, the bill seeks to alleviate some of the financial burdens on insured individuals. This change is particularly relevant in a healthcare landscape where high out-of-pocket costs can be a barrier to necessary medications, making it easier for patients to manage their healthcare expenses and incentivizing adherence to prescribed treatments.

Summary

House Bill 4719 aims to amend the Insurance Code of 1956 by adding section 3406z, which modifies the calculation of out-of-pocket maximums and cost-sharing requirements for health insurance policies that cover prescription drugs in Michigan. The bill mandates that amounts paid by an enrollee, or on their behalf, must be included when determining their financial contributions toward these limits. This inclusion applies to both standard health insurance policies and high deductible health plans, with certain conditions to maintain compliance with federal tax laws regarding health savings accounts.

Contention

However, the bill may raise concerns among insurance providers regarding the potential for increased costs. Insurance companies might argue that including such payments could lead to higher premiums or alter policy structures, as they will need to account for these changes in their pricing models. Additionally, there may be discussions regarding the administration and the complexity of implementing these changes, especially in a state that already struggles with healthcare affordability issues. Stakeholders will need to consider how these regulations align with existing federal laws and how they impact the coverage landscape moving forward.