| 1 | 1 | | FIRSTREGULARSESSION |
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| 2 | 2 | | HOUSEBILLNO.79 |
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| 3 | 3 | | 103RDGENERALASSEMBLY |
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| 4 | 4 | | INTRODUCEDBYREPRESENTATIVEHRUZA. |
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| 5 | 5 | | 1047H.01I DANARADEMANMILLER,ChiefClerk |
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| 6 | 6 | | ANACT |
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| 7 | 7 | | Toamendchapter376,RSMo,byaddingtheretoonenewsectionrelatingtocost-sharing |
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| 8 | 8 | | underhealthbenefitplans. |
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| 9 | 9 | | BeitenactedbytheGeneralAssemblyofthestateofMissouri,asfollows: |
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| 10 | 10 | | SectionA.Chapter376,RSMo,isamendedbyaddingtheretoonenewsection,tobe |
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| 11 | 11 | | 2knownassection376.448,toreadasfollows: |
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| 12 | 12 | | 376.448.1.Asusedinthissection,thefollowingtermsmean: |
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| 13 | 13 | | 2 (1)"Cost-sharing",anyco-payment,coinsurance,deductible,amountpaidby |
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| 14 | 14 | | 3anenrolleeforhealthcareservicesinexcessofacoveragelimitation,orsimilarcharge |
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| 15 | 15 | | 4requiredbyoronbehalfofanenrolleeinordertoreceiveaspecifichealthcareservice |
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| 16 | 16 | | 5coveredbyahealthbenefitplan,whethercoveredundermedicalbenefitsorpharmacy |
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| 17 | 17 | | 6benefits.Theterm"cost-sharing"shallincludecost-sharingasdefinedin42U.S.C. |
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| 18 | 18 | | 7Section18022(c); |
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| 19 | 19 | | 8 (2)"Enrollee",thesamemeaninggiventotheterminsection376.1350; |
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| 20 | 20 | | 9 (3)"Genericdrug",thesamemeaninggiventothetermin42CFR423.4; |
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| 21 | 21 | | 10 (4)"Healthbenefitplan",thesamemeaninggiventotheterminsection |
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| 22 | 22 | | 11376.1350; |
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| 23 | 23 | | 12 (5)"Healthcareservice",thesamemeaninggiventotheterminsection |
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| 24 | 24 | | 13376.1350; |
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| 25 | 25 | | 14 (6)"Healthcarrier",thesamemeaninggiventotheterminsection376.1350; |
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| 26 | 26 | | 15 (7)"Pharmacybenefitsmanager",thesamemeaninggiventotheterminsection |
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| 27 | 27 | | 16376.388. |
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| 28 | 28 | | EXPLANATION—Matterenclosedinbold-facedbrackets[thus] intheabovebillisnotenactedandis |
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| 29 | 29 | | intendedtobeomittedfromthelaw.Matterinbold-facetypeintheabovebillisproposedlanguage. 17 2.Whencalculatinganenrollee'soverallcontributiontoanyout-of-pocket |
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| 30 | 30 | | 18maximumoranycost-sharingrequirementunderahealthbenefitplan,ahealthcarrier |
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| 31 | 31 | | 19orpharmacybenefitsmanagershallincludeanyamountspaidbytheenrolleeorpaid |
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| 32 | 32 | | 20onbehalfoftheenrolleeforanymedicationwhereagenericdrugsubstituteforsuch |
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| 33 | 33 | | 21medicationisnotavailable. |
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| 34 | 34 | | 22 3.Ahealthcarrierorpharmacybenefitsmanagershallnotvaryanenrollee's |
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| 35 | 35 | | 23out-of-pocketmaximumoranycost-sharingrequirementbasedon,orotherwisedesign |
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| 36 | 36 | | 24benefitsinamannerthattakesintoaccount,theavailabilityofanycost-sharing |
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| 37 | 37 | | 25assistanceprogramforanymedicationwhereagenericdrugsubstituteforsuch |
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| 38 | 38 | | 26medicationisnotavailable. |
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| 39 | 39 | | 27 4.If,underfederallaw,applicationoftherequirementundersubsection2ofthis |
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| 40 | 40 | | 28sectionwouldresultinhealthsavingsaccountineligibilityunderSection223ofthe |
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| 41 | 41 | | 29InternalRevenueCodeof1986,asamended,therequirementundersubsection2ofthis |
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| 42 | 42 | | 30sectionshallapplytohealthsavingsaccount-qualifiedhighdeductiblehealthplanswith |
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| 43 | 43 | | 31respecttoanycost-sharingofsuchaplanaftertheenrolleehassatisfiedtheminimum |
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| 44 | 44 | | 32deductibleunderSection223,exceptwithrespecttoitemsorservicesthatare |
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| 45 | 45 | | 33preventivecareunderSection223(c)(2)(C)oftheInternalRevenueCodeof1986,as |
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| 46 | 46 | | 34amended,inwhichcasetherequirementofsubsection2ofthissectionshallapply |
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| 47 | 47 | | 35regardlessofwhethertheminimumdeductibleunderSection223hasbeensatisfied. |
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| 48 | 48 | | 36 5.Nothinginthissectionshallprohibitahealthcarrierorhealthbenefitplan |
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| 49 | 49 | | 37fromutilizingsteptherapyinaccordancewithsection376.2034. |
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| 50 | 50 | | 38 6.Theprovisionsofthissectionshallnotapplytohealthbenefitplansthatare |
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| 51 | 51 | | 39coveredundertheLaborManagementRelationsActof1947,29U.S.C.Section141et |
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| 52 | 52 | | 40seq.,asamended. |
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| 53 | 53 | | 41 7.Theprovisionsofthissectionshallapplytohealthbenefitplansenteredinto, |
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| 54 | 54 | | 42amended,extended,orrenewedonorafterAugust28,2025. |
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| 55 | 55 | | âś” |
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| 56 | 56 | | HB79 2 |
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