SENATE DOCKET, NO. 491        FILED ON: 1/16/2013

SENATE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 477

The Commonwealth of Massachusetts

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PRESENTED BY:

Anthony W. Petruccelli

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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 patient financial protection.

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PETITION OF:

SENATE DOCKET, NO. 491        FILED ON: 1/16/2013

SENATE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 477

The Commonwealth of Massachusetts

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In the Year Two Thousand Thirteen

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An Act relative to patient financial protection.

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
 

SECTION 1. Chapter 175 of the General Laws is hereby amended by inserting after section 47BB the following two sections:-

Section 47CC.  (a) Any policy, contract, agreement, plan or certificate of insurance issued, delivered or renewed within the commonwealth that provides coverage for prescription drugs shall establish a separate out-of-pocket limit for prescription drugs, including specialty drugs, limited to no more for self-only and family coverage per year than the minimum dollar amounts in effect under Section 223(c)(2)(A)(i) of the Internal Revenue Code of 1986 for self-only and family coverage, respectively. For the purposes of this section, the use of the term "out-of-pocket limit" must be consistent with the definitions of those terms as prescribed by the Secretary of the United States Department of Health and Human Services pursuant to Section 2715 of the federal Affordable Care Act.

SECTION 3. Chapter 176A of the General Laws is hereby amended by inserted after section 8EE the following section:-

Section 8FF. (a) Any contract between a subscriber and the corporation under an individual or group hospital service plan which is delivered, issued or renewed within the commonwealth that provides coverage for prescription drugs shall establish a separate out-of-pocket limit for prescription drugs, including specialty drugs, limited to no more for self-only and family coverage per year than the minimum dollar amounts in effect under               Section 223(c)(2)(A)(i) of the Internal Revenue Code of 1986 for self-only and family coverage, respectively. For the purposes of this section, the use of the term "out-of-pocket limit" must be consistent with the definitions of those terms as prescribed by the Secretary of the United States Department of Health and Human Services pursuant to Section 2715 of the federal Affordable Care Act.

SECTION 4. Chapter 176B of the General Laws is hereby amended by inserted after section 4EE the following section:-

Section 4FF. (a) Any subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth that provides coverage for prescription drugs shall establish a separate out-of-pocket limit for prescription drugs, including specialty drugs, limited to no more for self-only and family coverage per year than the minimum dollar amounts in effect under Section 223(c)(2)(A)(i) of the Internal Revenue Code of 1986 for self-only and family coverage, respectively. For the purposes of this section, the use of the term "out-of-pocket limit" must be consistent with the definitions of those terms as prescribed by the Secretary of the United States Department of Health and Human Services pursuant to Section 2715 of the federal Affordable Care Act.

SECTION 5. Chapter 176G of the General Laws is hereby amended by inserted after Section 4W the following section:-

Section 4X. (a) Any individual or group health maintenance that provides coverage for prescription drugs shall establish a separate out-of-pocket limit for prescription drugs, including specialty drugs, limited to no more for self-only and family coverage per year than the minimum dollar amounts in effect under Section 223(c)(2)(A)(i) of the Internal Revenue Code of 1986 for self-only and family coverage, respectively. For the purposes of this section, the use of the term "out-of-pocket limit" must be consistent with the definitions of those terms as prescribed by the Secretary of the United States Department of Health and Human Services pursuant to Section 2715 of the federal Affordable Care Act.

SECTION 6. Sections 2 to 6, inclusive, shall apply to all policies, contracts and certificates of health insurance subject to section 17K of chapter 32A, section 47CC of chapter 175, section 8FF of chapter 176A, section 4FF of chapter 176B and section 4X of chapter 176G of the General Laws which are delivered, issued or renewed on or after January 1, 2014.