Relating to health carriers, pharmacy benefits managers, and the calculation of cost-sharing contributions by covered persons

This bill relates to health carriers, pharmacy benefits managers, and the calculation of cost-sharing covered persons. “Cost-sharing” and “health carrier” are defined in the bill. Under the bill, when a health carrier calculates a covered person’s overall contribution to any cost-sharing requirement under a health benefit plan, the health carrier and pharmacy benefits manager shall include any amount paid by the covered person, or paid by another person on behalf of the covered person. Where the contribution calculation would result in the ineligibility of a health savings account (HSA) under section 223 of the Internal Revenue Code (IRC), the contribution calculation for the HSA shall apply only after the covered person has satisfied the minimum deductible, except that for items or services that are preventive care pursuant to section 223(c)(2)(C) of the IRC, the contribution calculation shall apply regardless of whether the minimum deductible has been satisfied. The bill applies to health benefit plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2026, as enumerated in the bill. The bill specifies the types of specialized health-related insurance not subject to the bill. The commissioner of insurance may adopt rules to administer the bill.