WeVote
Log In

Bill

Bill

HB 1246

Health Benefit Plans - Calculation of Cost-Sharing Contribution - Requirements

2025 Regular Session Introduced by Tiffany Alston and 17 co-sponsors

Maryland bill requires health insurers to calculate patient cost-sharing based on actual negotiated rates instead of inflated standard charges, reducing surprise out-of-pocket costs.

Third Reading Passed
0
WeVote Research Nonpartisan
Bill Summary · HB 1246

Legislative bill overview

HB 1246 modifies how health insurance plans calculate cost-sharing contributions (copays, coinsurance, deductibles) by requiring insurers to base these calculations on actual negotiated rates rather than inflated "usual and customary" charges. The bill aims to prevent situations where patients face unexpectedly high out-of-pocket costs when providers bill above negotiated amounts.

Why is this important

Many patients experience surprise medical bills when their cost-sharing is calculated against outdated or artificially high reference rates, resulting in significantly higher copays or deductibles than anticipated. This reform could reduce out-of-pocket expenses for Maryland residents and increase transparency around actual insurance costs, though savings depend on how broadly the bill applies and what baseline rates insurers must use.

Potential points of contention

  • Insurance industry costs: Insurers may argue the change reduces their negotiating leverage and could increase premiums across the board
  • Provider billing complexity: Different plans have different negotiated rates with the same providers, creating administrative challenges and potential coding/billing disputes
  • Definition ambiguity: The bill's amendments likely clarified language, but questions may remain about which rates apply to out-of-network providers and emergency situations

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

Sign in to ask a question.