Enrollee's contribution toward cost-sharing and out-of-pocket maximum requirements calculation establishment provision

Summary

The bill tells insurers and pharmacy benefit managers to include any money an enrollee pays—or that is paid for them—when figuring their share of co‑pays, coinsurance, deductibles and out‑of‑pocket limits. It applies to prescription drugs whether they fall under medical or pharmacy benefits and only after the enrollee meets the plan deductible if earlier calculations would affect HSA or catastrophic plan eligibility. The rule takes effect on Jan. 1, 2027 for new or renewed plans.

AI-generated summary — may be incomplete or inaccurate. Verify against the official bill text.

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