SF3604

Purpose

This bill would require health plan companies to be transparent about whether funds from a patient assistance program (PAP) were used to reduce an enrollee’s deductible. The goal is to clearly inform consumers about how PAP funds affect their out-of-pocket costs.

Main Provisions

• Creates a new disclosure requirement in Minnesota law (Section 62Q.671) about the application of PAP funds to deductibles.
• In the health plan’s Summary of Benefits and Coverage (SBC), the health plan company must include a statement indicating whether money from a PAP was applied to an enrollee’s deductible.
• The PAP is defined as referenced in Minnesota statute 62J.84, subdivision 2, paragraph h.

Significant Changes to Existing Law

• Adds a new statutory requirement (in Chapter 62Q) that mandates transparency about PAP funds used toward deductibles.
• Requires health plans to communicate, in their SBC, specific information about how PAP funds impact deductibles, potentially affecting how consumers compare plans based on out-of-pocket costs.

Implications

• Consumers will have clearer information about whether PAP funds reduce deductibles, which can influence plan selection and understanding of potential costs.
• Health plans will need to adjust their SBCs to include this new disclosure language.

Definitions and Scope

• Health plan, Summary of Benefits and Coverage (SBC), deductible, patient assistance program (PAP).
• PAP definition tied to Minnesota Statutes 62J.84, subdivision 2, paragraph h.
• Enrollee deductible: the out-of-pocket cost that the enrollee must pay before the plan begins to pay.

Relevant Terms patient assistance program, PAP, deductible, summary of benefits and coverage, SBC, health plan, enrollees deductible, Minnesota Statutes, 62Q, 62J.84, disclosure, transparency, cost-sharing, out-of-pocket costs