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SF 3993

Health plans to credit enrollees for services provided by out-of-network provider at a lower cost than the plan's in-network providers

2025-2026 Regular Session Introduced by Rich Draheim

Health plans must credit enrollees when out-of-network care is cheaper than in-network options, aligning costs with actual lower market prices.

Referred to Commerce and Consumer Protection
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Bill Summary · SF 3993

Summary: SF 3993 (Minnesota) — Health Plan Credits for Out-of-Network Services Provided at Lower Cost

Overview

SF 3993 is a Minnesota bill introduced in the 2025-2026 session. The bill directs health plans to credit enrollees for services provided by an out-of-network provider when those services are delivered at a lower cost than the plan’s in-network providers. The measure aims to ensure enrollees receive cost-based credits or rebates comparable to or better than what they would obtain through the plan’s in-network arrangements.

  • Status: Introduced and referred to the Committee on Commerce and Consumer Protection (as of 2026-03-02)
  • Introduction Date: 2026-03-02
  • Sponsor: Co-sponsor Rich Draheim

Purpose and Intent

The bill seeks to:

  • Promote consumer value by ensuring enrollees who receive care from an out-of-network (OON) provider at a lower cost than the plan’s in-network (IN) options receive corresponding financial credit.
  • Align patient financial responsibility with actual market costs when OON services are cheaper than IN alternatives.
  • Potentially incentivize patients to seek lower-cost care, regardless of network status, when it is more cost-effective.

Key Provisions (Summary of Potential Provisions Based on Title and Purpose)

Note: The bill’s full text would provide precise mechanisms. Based on the title, the following provisions are typically involved in similar measures:

  • Credit Mechanism for OON Services: Health plans must credit enrollees’ out-of-pocket costs or provide reimbursement/credit if an OON service is performed at a cost lower than the plan’s negotiated IN rate.
  • Cost Comparison Requirements: Plans may be required to determine a cost comparison between OON charges and the plan’s IN network rates for the same service, considering covered benefits and applicable deductibles, copays, and coinsurance.
  • Communication and Disclosure: Plans may need to disclose to enrollees how credits are calculated, including the basis for the OON cost determination and the timing of credits or reimbursements.
  • Timelines for Credits/Reimbursements: Specific timeframes within which the credit or reimbursement must be issued to the enrollee following service delivery or claim adjudication.
  • Applicability: The measure would apply to health plans offered to Minnesota residents, potentially including fully insured, self-insured (employer-provided) plans, and/or excepted benefits depending on the final text.
  • Administrative Procedures: Requirements for plan administrators to implement systems for identifying eligible OON services at lower cost and applying credits consistently.

Who is Affected

  • Enrollees/Members: Individuals covered under Minnesota health plans who receive care from out-of-network providers at lower costs than IN network services.
  • Health Plan Issuers: Insurance companies and plan administrators responsible for implementing credit or reimbursement mechanisms.
  • Employers with Self-Insured Plans (potentially): If the bill covers self-insured plans, employers would also be affected as sponsors of those plans.

Potential Impact

  • For Consumers: Potentially lower out-of-pocket spending when OON services are cheaper than IN options, improving affordability and access.
  • For Health Plans: Administrative adjustment to calculate and issue credits/reimbursements; possible impact on negotiated IN rates and network strategies.
  • Market Effects: Could influence patient behavior toward seeking OON care when cost-effective, even within the same plan.
  • Regulatory Considerations: Adds a regulatory requirement on plan administrators to determine and apply credits, with potential compliance costs.

Procedural and Timeline Aspects

  • Current Stage: Introduction and first reading; referral to the Commerce and Consumer Protection committee.
  • Next Steps: Committee analysis, potential amendments, floor votes, and passage in the Minnesota Legislature, followed by potential governor action for enactment.

If you’d like, I can tailor this summary to include a line-by-line comparison with existing Minnesota health plan credit or surprise-balance provisions, or draft a plain-language summary for consumer audiences.

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

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