MN SF3667

Health plan companies must count payments made by enrollees to out-of-network providers toward the enrollee's annual deductible, the same as payments to in-network providers.

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

After the enrollee meets the deductible, the health plan may still require services from in-network providers or require higher cost-sharing amounts for out-of-network provider services.

Health plan companies are not required to pay for out-of-network services unless the plan terms require it, and the bill does not mandate coverage for services not covered under the plan.

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