Amendment #1169 to H3600

GIC Out of Pocket Cap

Representatives Mark of Peru, Garballey of Arlington, Donahue of Worcester, Ultrino of Malden, Balser of Newton, Cahill of Lynn, Linsky of Natick, Vega of Holyoke, Smizik of Brookline, Fiola of Fall River, Collins of Boston, Scaccia of Boston, Tosado of Springfield, Chan of Quincy, Lewis of Framingham, Gordon of Bedford, Garlick of Needham, Crighton of Lynn, McMurtry of Dedham, Murray of Milford, Connolly of Cambridge, Keefe of Worcester, Puppolo of Springfield, Garry of Dracut, Dwyer of Woburn, Cutler of Duxbury, Finn of West Springfield, Day of Stoneham, DiZoglio of Methuen, Barber of Somerville, Gentile of Sudbury and DuBois of Brockton moves to amend the bill by adding the following section:

“Section XXXX. Section 6 of chapter 32A of the General Laws is hereby amended by inserting after the fourth sentence thereof the following new sentence: -

For active and retired employees, their dependents and the survivors of deceased employees, including municipal subscribers, the maximum amount of deductibles and copayments for covered services during an enrollment year in a plan shall not exceed $2,500 for individual coverage and $5,000 for family coverage.

SECTION XX. Section 6 of chapter 32A is hereby further amended by inserting at the end thereof the following new paragraph: -

The commonwealth shall deposit any and all federal subsidies that it receives from the retiree drug subsidy program under the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (P.L. 108-173), into an account to be administered by the commission. The commission may expend amounts in the account to pay the costs of a subscriber’s deductibles and copayments for covered services that exceed $2,500 for individual coverage and $5,000 for family coverage but are less than $5,000 and $10,000 respectively.

SECTION XX. Subsection (b) Section 22 of Chapter 32B is hereby amended by striking the first paragraph and inserting the following new paragraph:-

(b) An appropriate public authority may increase the dollar amounts for copayments, deductibles, tiered provider network copayments and other cost-sharing plan design features; provided that, for subscribers enrolled in a non-Medicare plan, such features do not exceed plan design features offered by the commission pursuant to section 4 or 4A of chapter 32A in a non-Medicare plan with the largest subscriber enrollment and, for subscribers enrolled in a Medicare plan under section 18A, such features do not exceed plan design features offered by the commission pursuant to section 4 or 4A of chapter 32A in a Medicare plan with the largest subscriber enrollment; provided that for active and retired employees, their dependents and the survivors of deceased employees the maximum amount of health insurance deductibles and copayments for covered services during an enrollment year in a plan shall not exceed those offered by the commission; provided, however, that the public authority need only satisfy the requirements of subsection (a) of section 21 the first time changes are implemented pursuant to this section; and provided, further that the public authority meet its obligations under subsections (b) to (h), inclusive, of section 21 each time an increase to a plan design feature is proposed.".

Additional co-sponsor(s) added to Amendment #1169 to H3600

GIC Out of Pocket Cap