1.1 A bill for an act
1.2 relating to health insurance; setting requirements for the calculation of an enrollee's
1.3 contribution toward cost-sharing and out-of-pocket maximum requirements;
1.4 proposing coding for new law in Minnesota Statutes, chapter 62Q.
1.5BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.6 Section 1. [62Q.491] COST-SHARING OR OUT-OF-POCKET MAXIMUM
1.7REQUIREMENTS; ENROLLEE CONTRIBUTION.
1.8 Subdivision 1.Definitions.(a) For purposes of this section, the following terms have
1.9the meanings given.
1.10 (b) "Cost-sharing" means co-pays, coinsurance, and deductibles.
1.11 (c) "Pharmacy benefit manager" has the meaning given in section 62W.02, subdivision
1.1215.
1.13 Subd. 2.Calculation.(a) When calculating an enrollee's overall contribution to a
1.14cost-sharing or out-of-pocket maximum requirement, a health plan company or pharmacy
1.15benefit manger must include any amount paid by an enrollee or paid on behalf of an enrollee
1.16by another person. The requirement under this paragraph applies to prescription drugs
1.17approved for coverage by the health plan company, whether the prescription drugs are
1.18covered under a medical or pharmacy benefit.
1.19 (b) If application of this section before an enrollee has met the enrollee's plan deductible
1.20results in (1) health savings account ineligibility under United States Code, title 26, section
1.21223, or (2) catastrophic health plan ineligibility under United States Code, title 42, section
1Section 1.
REVISOR RSI/CH 25-0459803/11/25
State of Minnesota
This Document can be made available
in alternative formats upon request
HOUSE OF REPRESENTATIVES
H. F. No. 3123
NINETY-FOURTH SESSION
Authored by Her04/07/2025
The bill was read for the first time and referred to the Committee on Commerce Finance and Policy 2.118022(e), this section applies to calculations only after the enrollee has met the enrollee's
2.2plan deductible.
2.3 EFFECTIVE DATE.This section is effective January 1, 2026, and applies to health
2.4plans offered, issued, or renewed on or after that date.
2Section 1.
REVISOR RSI/CH 25-0459803/11/25