Health plan enrollee's contribution toward and out-of-pocket maximum or cost sharing calculation requirements establishment
Summary
SF 628 would require health plan companies, to the extent allowed by federal law, to count amounts paid by an enrollee or paid on the enrollee’s behalf by another person when determining whether the enrollee has met an out-of-pocket maximum or other cost-sharing limit under a health plan. In practical terms, the bill is aimed at ensuring that third-party payments and certain direct payments made for a person’s care are credited toward the person’s deductible, copayment, coinsurance, or annual cost-sharing cap.
The bill defines “cost sharing” to include copayments, coinsurance, and deductibles, and it would apply to health plans offered, issued, or renewed on or after January 1, 2026. The measure would add a new section to Minnesota Statutes, chapter 62Q, governing health plan requirements.
Impact
If enacted, the bill would change how Minnesota health insurers calculate enrollees’ progress toward out-of-pocket maximums and cost-sharing obligations, potentially reducing the amount consumers must pay before coverage becomes more generous. It would impose a new statutory requirement on health plan companies in chapter 62Q, while preserving compliance only “to the extent permitted by federal law,” which suggests the state rule would operate within federal insurance and benefits constraints.
Sentiment
The available record shows a neutral-to-supportive posture, with the bill introduced and referred to the Senate Commerce and Consumer Protection Committee and no recorded votes or committee testimony provided in the materials. The absence of opposition in the record, combined with the consumer-protection framing of the bill, suggests the measure was presented as a benefit to insured individuals rather than a controversial policy change.
Contention
The main potential point of contention is the bill’s interaction with federal law, since the requirement applies only “to the extent permitted by federal law,” leaving open questions about preemption and implementation. Another likely issue is the effect on insurers and plan administration, because counting third-party or other payments toward cost-sharing limits can affect plan liability, premium pricing, and how health plans handle assistance programs or payments made on behalf of enrollees.
Includes any costs paid by an enrollee or on behalf of the enrollee by a third party when calculating an enrollee’s overall contribution to any out-of-pocket maximum or cost sharing requirement under a health plan as of January 1, 2026.
Includes any costs paid by an enrollee or on behalf of the enrollee by a third party when calculating an enrollee’s overall contribution to any out-of-pocket maximum or cost sharing requirement under a health plan as of January 1, 2026.
Includes any costs paid by an enrollee or on behalf of the enrollee, by a third party when calculating an enrollee’s overall contribution to any out-of-pocket maximum or cost sharing requirement, under a health plan as of January 1, 2027.
Includes any costs paid by an enrollee or on behalf of the enrollee by a third party when calculating an enrollee’s overall contribution to any out-of-pocket maximum or cost sharing requirement under a health plan as of January 1, 2027.