Bill
S 698
Massachusetts S.698 requires insurers to count all cost-sharing payments, including third-party and upfront payments, immediately toward enrollees’ deductibles and out-of-pocket li
Note on source material
- The materials provided appear to mix multiple, inconsistent documents (different titles, texts, jurisdictions, sponsors, and procedural histories). Because of that, this summary separately describes the two primary substantive texts included in the packet:
1. An “Introduced Version” amending New Jersey’s Community College Opportunity Grant Program (P.L.2021, c.26), and
2. A Massachusetts bill (Senate No. 698 / “An Act relative to consumer deductibles”) addressing how cost‑sharing payments count toward enrollee deductibles and out‑of‑pocket limits.
- The stated bill title (“Relates to financial loss as a result of a failed in‑vitro fertilization or intrauterine insemination”) does not appear in the text provided, so it is not summarized here. If you intended a different bill, please supply the correct text or clarify.
Summary A — Amendments to New Jersey’s Community College Opportunity Grant Program (Introduced Version)
Purpose
- Clarifies and expands definitions and eligibility rules for the Community College Opportunity Grant Program (P.L.2021, c.26) to explicitly include county vocational school districts and postsecondary career and technical education (CTE) programs.
Key provisions and changes
- Definitions: Adds/clarifies terms including “adult student,” “career and technical education course or program,” “approved educational fees,” “out‑of‑county college/vocational school district,” and “three plus one degree program.”
- “Approved educational fees” expressly include typical fees (tuition‑adjacent fees, lab, technology, program/course fees) and limits them to available appropriations.
- Eligibility amendments:
- Explicitly includes adult students enrolled in CTE programs at county vocational school districts (minimum program duration specified).
- Clarifies residency rules for county college and county vocational district enrollees.
- Allows grants to cover in‑district/in‑county rates for out‑of‑county attendance (not to exceed actual charged amounts).
- Confirms income eligibility (between $0 and $65,000, with authority able to set higher maximums) and other standard requirements (FAFSA/financial aid filing, no outstanding grant refund or loan default unless repayment arranged, good academic standing).
- Administration: Grants administered by the Higher Education Student Assistance Authority; Student Success Incentive funding administered by the Office of the Secretary of Higher Education.
Who is affected
- County college students and adult students in county vocational school district CTE programs in New Jersey, county colleges and vocational districts (administrative and funding effects), and the Higher Education Student Assistance Authority / Secretary of Higher Education.
Procedural/timing notes
- The text amends P.L.2021, c.26; procedural history is included in the packet but may refer to multiple separate bills—see note above.
Summary B — Massachusetts: Consumer Deductibles (S.698 / insertion to Chapter 176O)
Purpose
- Require insurers to count any cost‑sharing payments (by the enrollee or paid on behalf of the enrollee) immediately and fully toward the enrollee’s deductible, out‑of‑pocket costs, or annual limitation on cost sharing.
Key provisions
- Definitions: “Insurer,” “cost sharing requirement,” “enrollee,” “health plan,” “health care service,” and “person” are defined consistent with federal/insurance usage.
- Core rule: When calculating an enrollee’s contribution toward any cost‑sharing requirement (copay, coinsurance, deductible, or annual limit), insurers must include payments made by the enrollee or on behalf of the enrollee by another person. Any reductions made for an enrollee’s benefit must be applied in full immediately toward the enrollee’s out‑of‑pocket obligations.
- Annual limitation: When calculating the enrollee’s contribution to the federal annual limitation on cost sharing (per 42 U.S.C. § 18022(c) and § 300gg‑6(b)), insurers must include expenditures for services that are covered and categorized as essential health benefits.
- Effective date: Applies to health plans entered into, amended, extended, or renewed on or after January 1, 2026.
- Rulemaking: The relevant Commission may promulgate rules to implement the section.
Who is affected
- Insurers offering health plans under state regulation in Massachusetts (including state and local governmental employer plans) and enrollees in those plans. Third‑party payers who assist enrollees (e.g., family members, charities) will see their payments counted immediately toward enrollee cost‑sharing.
Potential impacts
- Prevents insurers from withholding credit for third‑party or upfront patient payments when calculating deductibles/OOP maximums, which can reduce unexpected financial burden for enrollees.
- Could change insurer billing and remittance/claim processing practices; may require systems changes to ensure immediate crediting.
- Helps ensure that payments for essential health benefits count toward the federal out‑of‑pocket cap where applicable.
Procedural/timing notes and inconsistencies
- The packet lists varied legislative actions, multiple sponsors from different jurisdictions, and a substitution reference (SUBSTITUTED BY A3795). These items appear to belong to distinct bills or sessions. If you need a focused summary for a single, authoritative bill (e.g., the IVF loss bill in your title or one of the two texts summarized above), please supply the exact bill text or confirm which jurisdiction/version to prioritize.
Compiled from official sources — confirm details with the bill’s official record.
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