HOUSE DOCKET, NO. 788        FILED ON: 1/17/2023

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 953

 

The Commonwealth of Massachusetts

_________________

PRESENTED BY:

Daniel Cahill

_________________

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 consumer deductibles.

_______________

PETITION OF:

 

Name:

District/Address:

Date Added:

Daniel Cahill

10th Essex

1/17/2023

Carmine Lawrence Gentile

13th Middlesex

6/14/2023

John Barrett, III

1st Berkshire

6/14/2023

David F. DeCoste

5th Plymouth

6/14/2023

Samantha Montaño

15th Suffolk

6/14/2023

Jeffrey Rosario Turco

19th Suffolk

6/14/2023

Adam J. Scanlon

14th Bristol

6/14/2023

Margaret R. Scarsdale

1st Middlesex

6/14/2023

Dawne Shand

1st Essex

8/17/2023

Tommy Vitolo

15th Norfolk

9/19/2023

Edward R. Philips

8th Norfolk

9/26/2023

Brian M. Ashe

2nd Hampden

11/27/2023

David Paul Linsky

5th Middlesex

12/18/2023


HOUSE DOCKET, NO. 788        FILED ON: 1/17/2023

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 953

By Representative Cahill of Lynn, a petition (accompanied by bill, House, No. 953) of Daniel Cahill relative to health insurance consumer deductibles.  Financial Services.

 

The Commonwealth of Massachusetts

 

_______________

In the One Hundred and Ninety-Third General Court
(2023-2024)

_______________

 

An Act relative to consumer deductibles.

 

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 176O of the General Laws, as appearing in the 2018 Official

Edition, is hereby amended by inserting after section 27 the following section:-

Section 28. (a) In this Section, the following terms shall have the following meanings:

“Insurer” means any health insurance issuer that is subject to state law regulating insurance and offers health insurance coverage, as defined in 42 U.S.C. § 300gg-91, or any state or local governmental employer plan.

“Cost sharing requirement” means any copayment, coinsurance, deductible, or annual limitation on cost sharing (including but not limited to a limitation subject to 42 U.S.C. §§ 18022(c) and 300gg-6(b)), required by or on behalf of an enrollee in order to receive a specific health care service, including a prescription drug, covered by a health plan.

“Enrollee” means any individual entitled to health care services from an insurer.

“Health plan” means a policy, contract, certification, or agreement offered or issued by an insurer to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services.

“Health care service” means an item or service furnished to any individual for the purpose of preventing, alleviating, curing, or healing human illness, injury or physical disability.

“Person” means a natural person, corporation, mutual company, unincorporated association, partnership, joint venture, limited liability company, trust, estate, foundation, not-for-profit corporation, unincorporated organization, government or governmental subdivision or agency.

(b) When calculating an enrollee’s contribution to any applicable cost sharing requirement, an insurer shall include any cost sharing amounts paid by the enrollee or on behalf of the enrollee by another person.  Any cost sharing or reductions made for an enrollee’s benefit or towards an enrollee’s applicable cost sharing requirement shall be applied in full at the time it is rendered and wholly towards the enrollee’s out of pocket costs, deductible, cost sharing or similar enrollee obligation.

(c)This section shall apply with respect to health plans that are entered into, amended, extended, or renewed on or after January 1, 2024.

(d) The Commission may promulgate such rules and regulations as it may deem necessary to implement this section.