ND
North Dakota House Bill HB1216

North Dakota 2025-2026 Regular Session

North Dakota House Bill HB1216 Compare Versions

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1-25.0068.04000
1+25.0068.01004
2+Title.03000
3+Adopted by the Human Services
4+Committee
25 Sixty-ninth
6+March 19, 2025
37 Legislative Assembly
48 of North Dakota
59 Introduced by
610 Representatives Karls, Hagert, Kiefert, Wagner
711 Senators Boschee, Dever, Sorvaag
812 A BILL for an Act to create and enact a new section to chapter 26.1-36 of the North Dakota
9-Century Code, relating to out-of-pocket expenses for prescription drugs; to amend and reenact
10-section 26.1-36.6-03 of the North Dakota Century Code, relating to self-insurance health care
11-plans; to provide for application; and to provide an effective date.
13+Century Code, relating to out-of-pocket expenses for prescription drugs; and to amend and
14+reenact section 26.1-36.6-03 of the North Dakota Century Code, relating to self-insurance
15+health care plans; and to provide for application.
1216 BE IT ENACTED BY THE LEGISLATIVE ASSEMBLY OF NORTH DAKOTA:
1317 SECTION 1. A new section to chapter 26.1-36 of the North Dakota Century Code is created
1418 and enacted as follows:
1519 Out - of - pocket expenses - Prescription drugs.
1620 1.As used in this section:
1721 a."Cost-sharing" means any coinsurance, copayment, or deductible under a health
1822 benefit plan.
1923 b."Enrollee" means an individual entitled to prescription drug coverage under a
2024 health benefit plan.
2125 c."Health benefit plan" has the same meaning as provided under section
2226 26.1 - 36.3 - 01.
2327 d."Prescription drug" means a drug for which a prescription is required:
2428 (1)Without a generic equivalent; or
25-(2)With a generic equivalent, if the enrollee has obtained access to the drug
29+(2)With a generic equivalent and the enrollee has obtained access to the drug
2630 through prior authorization, a step therapy protocol, or the heath care
2731 insurer's expectations and appeals process.
28-2.To the extent permitted by federal law and regulation, an insurer may not deliver,
29-issue, execute, or renew a health benefit plan providing prescription drug coverage
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3133 HOUSE BILL NO. 1216
32-HOUSE BILL NO. 1216
33-with Senate Amendments
34+PROPOSED AMENDMENTS TO
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56+2.To the extent permitted by federal law and regulation, an insurer may not deliver,
57+issue, execute, or renew a health benefit plan providing prescription drug coverage
5758 unless when calculating an enrollee's overall contribution to any out - of - pocket
5859 maximum or any cost - sharing requirement for a prescription drug under the health
5960 benefit plan, the health benefit plan provides for the inclusion of any amount paid by
6061 the enrollee or paid on behalf of the enrollee by another person. The health benefit
6162 plan may not vary the out - of - pocket maximum or cost - sharing requirement, or
62-otherwise design benefits accounting for the availability of a cost - sharing assistance
63-program for a prescription drug.
63+otherwise design benefits in a manner that takes into account the availability of a
64+cost - sharing assistance program for a prescription drug.
6465 3.If application of this section would result in ineligibility of a health benefit plan that is a
6566 qualified high - deductible health plan to qualify as a health savings account under
6667 section 223 of the Internal Revenue Code [26 U.S.C. 223], the requirements of this
6768 section do not apply with respect to the deductible of the health benefit plan until after
6869 the enrollee has satisfied the minimum deductible under section 26 U.S.C. 223.
6970 SECTION 2. AMENDMENT. Section 26.1-36.6-03 of the North Dakota Century Code is
7071 amended and reenacted as follows:
7172 26.1-36.6-03. Self-insurance health plans - Requirements. (Effective through July 31,
7273 2025)
7374 1.The following policy provisions apply to a self-insurance health plan or to the
7475 administrative services only or third-party administrator, and are subject to the
7576 jurisdiction of the commissioner: sections 26.1-36-03, 26.1-36-03.1, 26.1-36-05,
7677 26.1-36-10, 26.1-36-12, 26.1-36-12.4, 26.1-36-12.6, 26.1-36-13, 26.1-36-14,
7778 26.1-36-17, 26.1-36-18, 26.1-36-19, 26.1-36-23, 26.1-36-29, 26.1-36-37.1, 26.1-36-38,
7879 26.1-36-39, 26.1-36-41, 26.1-36-44, and 26.1-36-46.
7980 2.The following health benefit provisions applicable to a group accident and health
8081 insurance policy under chapter 26.1-36 apply to a self-insurance health plan and are
8182 subject to the jurisdiction of the commissioner: sections 26.1-36-06, 26.1-36-06.1,
8283 26.1-36-07, 26.1-36-08, 26.1-36-08.1, 26.1-36-09, 26.1-36-09.1, 26.1-36-09.2,
8384 26.1-36-09.3, 26.1-36-09.5, 26.1-36-09.6, 26.1-36-09.7, 26.1-36-09.8, 26.1-36-09.9,
8485 26.1-36-09.10, 26.1-36-09.11, 26.1-36-09.12, 26.1-36-09.13, 26.1-36-09.14,
8586 26.1-36-09.15, 26.1-36-11, 26.1-36-12.2, 26.1-36-20, 26.1-36-21, 26.1-36-22,
86-26.1-36-23.1, and 26.1-36-43. Section 54-52.1-04.18 applies to a self-insurance health
87-plan and is subject to the jurisdiction of the commissioner.
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87+Page No. 2 25.0068.01004
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120+26.1-36-23.1, and 26.1-36-43. Section 54-52.1-04.18 applies to a self-insurance health
121+plan and is subject to the jurisdiction of the commissioner.
121122 Self-insurance health plans - Requirements. (Effective after July 31, 2025)
122123 1.The following policy provisions apply to a self-insurance health plan or to the
123124 administrative services only or third-party administrator, and are subject to the
124125 jurisdiction of the commissioner: sections 26.1-36-03, 26.1-36-03.1, 26.1-36-05,
125126 26.1-36-10, 26.1-36-12, 26.1-36-12.4, 26.1-36-12.6, 26.1-36-13, 26.1-36-14,
126127 26.1-36-17, 26.1-36-18, 26.1-36-19, 26.1-36-23, 26.1-36-29, 26.1-36-37.1, 26.1-36-38,
127128 26.1-36-39, 26.1-36-41, 26.1-36-44, and 26.1-36-46.
128129 2.The following health benefit provisions applicable to a group accident and health
129130 insurance policy under chapter 26.1-36 apply to a self-insurance health plan and are
130131 subject to the jurisdiction of the commissioner: sections 26.1-36-06, 26.1-36-06.1,
131132 26.1-36-07, 26.1-36-08, 26.1-36-08.1, 26.1-36-09, 26.1-36-09.1, 26.1-36-09.2,
132133 26.1-36-09.3, 26.1-36-09.5, 26.1-36-09.6, 26.1-36-09.7, 26.1-36-09.8, 26.1-36-09.9,
133134 26.1-36-09.10, 26.1-36-09.11, 26.1-36-09.12, 26.1-36-09.13, 26.1-36-09.14,
134135 26.1-36-09.15, 26.1-36-11, 26.1-36-12.2, 26.1-36-20, 26.1-36-21, 26.1-36-22,
135136 26.1-36-23.1, and 26.1-36-43. Section 1 of this Act applies to a self-insurance health
136137 plan and is subject to the jurisdiction of the commissioner.
137-SECTION 3. APPLICATION. This Act applies effective January 1, 2026, to the public
138-employees retirement system uniform group insurance program health insurance benefits
139-coverage, regardless of the health insurance benefits coverage contract issuance or renewal
140-date. This Act applies effective January 1, 2026, or upon the next renewal after January 1,
141-2026, to health benefit plans.
142-SECTION 4. EFFECTIVE DATE. This Act becomes effective on January 1, 2026.
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138+SECTION 3. APPLICATION. This Act applies to health benefit plans that are delivered,
139+issued, executed, or renewed after the effective date of this Act.
140+Page No. 3 25.0068.01004
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