Requirements for the calculation of an enrollee's contribution toward cost-sharing and out-of-pocket maximum requirements set.
Enrollee's contribution toward cost-sharing and out-of-pocket maximum requirements calculation establishment provision
Enrollee's contribution toward an out-of-pocket maximum or cost sharing calculation requirements set.
Health plan enrollee's contribution toward and out-of-pocket maximum or cost sharing calculation requirements establishment
Includes any costs paid by an enrollee or on behalf of the enrollee by a third party when calculating an enrollee’s overall contribution to any out-of-pocket maximum or cost sharing requirement under a health plan as of January 1, 2026.
Includes any costs paid by an enrollee or on behalf of the enrollee by a third party when calculating an enrollee’s overall contribution to any out-of-pocket maximum or cost sharing requirement under a health plan as of January 1, 2026.
Includes any costs paid by an enrollee or on behalf of the enrollee, by a third party when calculating an enrollee’s overall contribution to any out-of-pocket maximum or cost sharing requirement, under a health plan as of January 1, 2027.
Includes any costs paid by an enrollee or on behalf of the enrollee by a third party when calculating an enrollee’s overall contribution to any out-of-pocket maximum or cost sharing requirement under a health plan as of January 1, 2027.
Health Benefit Plans - Calculation of Cost-Sharing Contribution - Requirements
Provide requirements for health carriers or pharmacy benefit managers regarding out-of-pocket maximums and cost-sharing requirements