1 New Section; Accident and Health Insurance; Fairness in Cost-Sharing Calculations. Amend RSA 415 by inserting after section 27 the following new section:

415:28 Fairness in Cost-Sharing Calculations.

I. In this section, "cost-sharing requirements" means any coinsurance, copayment, deductible or out-of-pocket maximum.

II. When calculating an enrollee's overall contribution to any cost-sharing requirements under an individual or group policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses, the insurer or pharmacy benefit manager shall include any amounts paid by the enrollee or paid on behalf of the enrollee. This requirement shall not apply in the case of a prescription drug for which there is a generic alternative, unless the insured has obtained prior authorization, a step therapy protocol, or the insurer's exceptions and appeals process. If under federal law, application of this requirement would result in health savings account ineligibility with section 223 of the federal Internal Revenue Code, this requirement shall apply for health savings account-qualified high deductible health plans with respect to the deductible of such a plan after the enrollee has satisfied the minimum deductible under section 223, except for with respect to items or services that are preventive care pursuant to section 223(c)(2)(C) of the federal Internal Revenue Code, in which case the requirements of this paragraph shall apply regardless of whether the minimum deductible under section 223 has been satisfied.

III. When applying paragraph II to the calculation of an enrollee or insured's contribution to the annual limitation on cost-sharing set forth in 42 U.S.C. sections 18022(c) and 300gg-6(b), an individual or group policy, plan, or contract of accident or health insurance, or pharmacy benefit manager shall include expenditures for any item or service covered by such insurer or pharmacy benefit manager and included within a category of essential health benefits as described in 42 U.S.C. section 18022(b)(1).

IV. This section shall apply to a group policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses delivered, issued for delivery, or renewed on or after January 1, 2026.

2 New Section; Health Service Corporations; Fairness in Cost-Sharing Calculations. Amend RSA 420-A by inserting after section 32 the following new section:

420-A:33 Fairness in Cost-Sharing Calculations.

I. "Cost-sharing requirements" has the same meaning as in RSA 415:28.

II. Every health service corporation and every similar corporation licensed under the laws of another state that issues or renews any policy, plan, or contract of individual or group accident or health insurance providing benefits for medical or hospital expenses, or pharmacy benefit manager when calculating an enrollee's overall contribution to any cost-sharing requirements shall include any amounts paid by the enrollee or paid on behalf of the enrollee. This requirement shall not apply in the case of a prescription drug for which there is a generic alternative, unless the insured has obtained prior authorization, a step therapy protocol, or the insurer's exceptions and appeals process. If under federal law, application of this requirement would result in health savings account ineligibility with section 223 of the federal Internal Revenue Code, this requirement shall apply for health savings account-qualified high deductible health plans with respect to the deductible of such a plan after the enrollee has satisfied the minimum deductible under section 223, except for with respect to items or services that are preventive care pursuant to section 223(c)(2)(C) of the federal Internal Revenue Code, in which case the requirements of this paragraph shall apply regardless of whether the minimum deductible under section 223 has been satisfied.

III. When applying paragraph II to the calculation of an enrollee or insured's contribution to the annual limitation on cost-sharing set forth in 42 U.S.C. sections 18022(c) and 300gg-6(b), an individual or group policy, plan, or contract of accident or health insurance, or pharmacy benefit manager shall include expenditures for any item or service covered by such insurer or pharmacy benefit manager and included within a category of essential health benefits as described in 42 U.S.C. section 18022(b)(1).

3 New Section; Health Maintenance Organizations; Fairness in Cost-Sharing Calculations. Amend RSA 420-B by inserting after section 26 the following new section:

420-B:27 Fairness in Cost-Sharing Calculations.

I. "Cost-sharing requirements" has the same meaning as in RSA 415:28.

II. Every health maintenance organization and every similar corporation licensed under the laws of another state that issues or renews any policy, plan, or contract of individual or group health insurance providing benefits for medical or hospital expenses, or pharmacy benefit manager when calculating an enrollee's overall contribution to any cost-sharing requirements shall include any amounts paid by the enrollee or paid on behalf of the enrollee. This requirement shall not apply in the case of a prescription drug for which there is a generic alternative, unless the insured has obtained prior authorization, a step therapy protocol, or the insurer's exceptions and appeals process. If under federal law, application of this requirement would result in health savings account ineligibility with section 223 of the federal Internal Revenue Code, this requirement shall apply for health savings account-qualified high deductible health plans with respect to the deductible of such a plan after the enrollee has satisfied the minimum deductible under section 223, except for with respect to items or services that are preventive care pursuant to section 223(c)(2)(C) of the federal Internal Revenue Code, in which case the requirements of this paragraph shall apply regardless of whether the minimum deductible under section 223 has been satisfied.

III. When applying paragraph II to the calculation of an enrollee or insured's contribution to the annual limitation on cost-sharing set forth in 42 U.S.C. sections 18022(c) and 300gg-6(b), an individual or group policy, plan, or contract of accident or health insurance, or pharmacy benefit manager shall include expenditures for any item or service covered by such insurer or pharmacy benefit manager and included within a category of essential health benefits as described in 42 U.S.C. section 18022(b)(1).

4 Effective Date. This act shall take effect 60 days after its passage.

1 New Section; Accident and Health Insurance; Fairness in Cost-Sharing Calculations. Amend RSA 415 by inserting after section 27 the following new section:

415:28 Fairness in Cost-Sharing Calculations.

I. In this section, "cost-sharing requirements" means any coinsurance, copayment, deductible or out-of-pocket maximum.

II. When calculating an enrollee's overall contribution to any cost-sharing requirements under an individual or group policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses, the insurer or pharmacy benefit manager shall include any amounts paid by the enrollee or paid on behalf of the enrollee. This requirement shall not apply in the case of a prescription drug for which there is a generic alternative, unless the insured has obtained prior authorization, a step therapy protocol, or the insurer's exceptions and appeals process. If under federal law, application of this requirement would result in health savings account ineligibility with section 223 of the federal Internal Revenue Code, this requirement shall apply for health savings account-qualified high deductible health plans with respect to the deductible of such a plan after the enrollee has satisfied the minimum deductible under section 223, except for with respect to items or services that are preventive care pursuant to section 223(c)(2)(C) of the federal Internal Revenue Code, in which case the requirements of this paragraph shall apply regardless of whether the minimum deductible under section 223 has been satisfied.

III. When applying paragraph II to the calculation of an enrollee or insured's contribution to the annual limitation on cost-sharing set forth in 42 U.S.C. sections 18022(c) and 300gg-6(b), an individual or group policy, plan, or contract of accident or health insurance, or pharmacy benefit manager shall include expenditures for any item or service covered by such insurer or pharmacy benefit manager and included within a category of essential health benefits as described in 42 U.S.C. section 18022(b)(1).

IV. This section shall apply to a group policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses delivered, issued for delivery, or renewed on or after January 1, 2026.

2 New Section; Health Service Corporations; Fairness in Cost-Sharing Calculations. Amend RSA 420-A by inserting after section 32 the following new section:

420-A:33 Fairness in Cost-Sharing Calculations.

I. "Cost-sharing requirements" has the same meaning as in RSA 415:28.

II. Every health service corporation and every similar corporation licensed under the laws of another state that issues or renews any policy, plan, or contract of individual or group accident or health insurance providing benefits for medical or hospital expenses, or pharmacy benefit manager when calculating an enrollee's overall contribution to any cost-sharing requirements shall include any amounts paid by the enrollee or paid on behalf of the enrollee. This requirement shall not apply in the case of a prescription drug for which there is a generic alternative, unless the insured has obtained prior authorization, a step therapy protocol, or the insurer's exceptions and appeals process. If under federal law, application of this requirement would result in health savings account ineligibility with section 223 of the federal Internal Revenue Code, this requirement shall apply for health savings account-qualified high deductible health plans with respect to the deductible of such a plan after the enrollee has satisfied the minimum deductible under section 223, except for with respect to items or services that are preventive care pursuant to section 223(c)(2)(C) of the federal Internal Revenue Code, in which case the requirements of this paragraph shall apply regardless of whether the minimum deductible under section 223 has been satisfied.

III. When applying paragraph II to the calculation of an enrollee or insured's contribution to the annual limitation on cost-sharing set forth in 42 U.S.C. sections 18022(c) and 300gg-6(b), an individual or group policy, plan, or contract of accident or health insurance, or pharmacy benefit manager shall include expenditures for any item or service covered by such insurer or pharmacy benefit manager and included within a category of essential health benefits as described in 42 U.S.C. section 18022(b)(1).

3 New Section; Health Maintenance Organizations; Fairness in Cost-Sharing Calculations. Amend RSA 420-B by inserting after section 26 the following new section:

420-B:27 Fairness in Cost-Sharing Calculations.

I. "Cost-sharing requirements" has the same meaning as in RSA 415:28.

II. Every health maintenance organization and every similar corporation licensed under the laws of another state that issues or renews any policy, plan, or contract of individual or group health insurance providing benefits for medical or hospital expenses, or pharmacy benefit manager when calculating an enrollee's overall contribution to any cost-sharing requirements shall include any amounts paid by the enrollee or paid on behalf of the enrollee. This requirement shall not apply in the case of a prescription drug for which there is a generic alternative, unless the insured has obtained prior authorization, a step therapy protocol, or the insurer's exceptions and appeals process. If under federal law, application of this requirement would result in health savings account ineligibility with section 223 of the federal Internal Revenue Code, this requirement shall apply for health savings account-qualified high deductible health plans with respect to the deductible of such a plan after the enrollee has satisfied the minimum deductible under section 223, except for with respect to items or services that are preventive care pursuant to section 223(c)(2)(C) of the federal Internal Revenue Code, in which case the requirements of this paragraph shall apply regardless of whether the minimum deductible under section 223 has been satisfied.

III. When applying paragraph II to the calculation of an enrollee or insured's contribution to the annual limitation on cost-sharing set forth in 42 U.S.C. sections 18022(c) and 300gg-6(b), an individual or group policy, plan, or contract of accident or health insurance, or pharmacy benefit manager shall include expenditures for any item or service covered by such insurer or pharmacy benefit manager and included within a category of essential health benefits as described in 42 U.S.C. section 18022(b)(1).

4 Effective Date. This act shall take effect 60 days after its passage.