MN HF4096

Health plan companies must count all payments made by enrollees to providers toward their annual deductible, regardless of whether the provider is in-network or out-of-network.

For out-of-network providers, the amount counting toward a deductible is capped at what the enrollee would have paid to an in-network provider for the same service if the actual amount paid is greater.

After an enrollee meets their deductible, health plans may still require use of in-network providers or impose higher cost-sharing amounts for out-of-network services.

Health plan companies are not required to pay for uncovered services or services from out-of-network providers unless the plan terms require it.

The law is effective January 1, 2019, and applies to health plans issued or renewed on or after that date.