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SF 4848

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

2025-2026 Regular Session Introduced by Liz Boldon and 3 co-sponsors

Establishes a standardized method for calculating an enrollee’s cost-sharing contributions and out-of-pocket maximum across health plans to improve transparency and consistency.

Referred to Commerce and Consumer Protection
#commerceandcommercedepartment #insurance-health
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Bill Summary · SF 4848

Summary of Minnesota Senate File 4848 (SF 4848)

Session

  • 2025-2026

Jurisdiction

  • Minnesota

Title

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

Current Status

  • Introduced and referred to the Senate Commerce and Consumer Protection Committee (as of 2026-03-25).
  • Sponsored in part by Liz Boldon, John Marty, Zach Duckworth, and Bobby Joe Champion.

1) Purpose and Intent

SF 4848 establishes a framework for calculating an enrollee’s required contribution toward cost-sharing and the out-of-pocket maximum (OOPM) under certain health plans or health coverage arrangements. The primary aim appears to be clarifying or standardizing how enrollees’ cost-sharing obligations are determined, potentially ensuring consistent application across plans and improving transparency for consumers.

2) Key Provisions and Changes (highlights)

  • Calculation Establishment Provision: Creates or codifies a method for determining:
    • The enrollee’s contribution toward cost-sharing (e.g., deductibles, copayments, and coinsurance) for health services.
    • The enrollee’s portion of the out-of-pocket maximum under applicable health plans.
  • Standardization/Rules: Likely sets specific rules, formulas, or benchmarks to apply when calculating costs, which may reduce variability between plans and ensure alignment with state consumer protections.
  • Scope of Application: Applies to health insurance policies or programs regulated by the state (e.g., public or private plans offered in Minnesota). May specify which types of plans are subject (e.g., individual, small group, or large group, depending on existing statutes).
  • Transparency and Communication: Potential requirements for disclosures to enrollees about how contributions toward cost-sharing and OOPM are calculated, possibly including statements in certificates of coverage, benefit summaries, or online materials.
  • Coordination with Existing Law: Likely references or harmonizes with Minnesota laws governing cost-sharing, out-of-pocket maximums, and consumer protections for health care billing.

Note: The bill’s text would provide the precise calculation method, thresholds, and any exceptions. The summary reflects the general objective inferred from the title and procedural status.

3) Affected Parties and Impacts

  • Enrollees/Consumers: Greater clarity on how their cost-sharing and OOPM are calculated; potential impact on out-of-pocket costs and financial planning for medical care.
  • Health Insurers and Health Plans: Required to apply the specified calculation method, which could influence plan design, billing practices, and disclosures.
  • Employers/Sponsors of Coverage: If self-insured or issuing group policies, may need to ensure compliance with the new calculation standard and any related reporting.
  • Health Care Providers and Billing Entities: Indirectly affected through standardized cost-sharing calculations that may influence patient billing communications.

4) Procedural and Timeline Considerations

  • Introduction: 2026-03-25
  • Committee Action: Referred to Commerce and Consumer Protection on the same date.
  • Next Steps: If reported out of committee, the bill would proceed to debate and potential floor votes in the Senate; subsequently, it would move to the House and follow the legislative process for enactment, potential amendments, and potential signature into law by the Governor.

5) Observations for Readers

  • The bill centers on how much enrollees owe for health services, specifically focusing on cost-sharing contributions and the out-of-pocket maximum.
  • It seeks to provide a standardized calculation approach, which can improve predictability for consumers and consistency across plans.
  • Details such as the exact formula, thresholds, exemptions, and effective dates will be defined in the bill’s text and any amended versions passed by the legislature.

Compiled from official sources — confirm details with the bill’s official record.

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