HELP Copays Act

Subjects: Health, Health care costs and insurance

Summary:  <p><strong>Help Ensure Lower Patient Copays Act or the HELP Copays Act</strong></p> <p>This bill requires health insurance plans to apply certain payments made by, or on behalf of, a plan enrollee toward a plan's cost-sharing requirements. Specifically, plans must apply third-party payments, financial assistance, discounts, product vouchers, and other reductions in out-of-pocket expenses toward the requirements.</p>

<html><body><pre>[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 1375 Introduced in Senate (IS)]

&lt;DOC&gt;






118th CONGRESS
  1st Session
                                S. 1375

    To amend title XXVII of the Public Health Service Act to apply 
additional payments, discounts, and other financial assistance towards 
the cost-sharing requirements of health insurance plans, and for other 
                               purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             April 27, 2023

 Mr. Marshall (for himself, Mr. Kaine, Ms. Ernst, Mr. Markey, and Ms. 
  Murkowski) introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
    To amend title XXVII of the Public Health Service Act to apply 
additional payments, discounts, and other financial assistance towards 
the cost-sharing requirements of health insurance plans, and for other 
                               purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Help Ensure Lower Patient Copays 
Act'' or the ``HELP Copays Act''.

SEC. 2. APPLICATION OF ADDITIONAL PAYMENTS, DISCOUNTS, AND OTHER 
              FINANCIAL ASSISTANCE TOWARD COST-SHARING REQUIREMENTS.

    (a) Application Toward Cost-Sharing Requirements.--Section 
2715(g)(1) of the Public Health Service Act (42 U.S.C. 300gg-15(g)(1)) 
is amended by adding at the end the following: ``In developing the 
standards for defining the terms `deductible', `co-insurance', `co-
payment', and `out-of-pocket limit' (as described in paragraph (2)), 
such standards shall provide that such terms include amounts paid by, 
or on behalf of, an individual enrolled in a group health plan or group 
or individual health insurance coverage, including third-party 
payments, financial assistance, discounts, product vouchers, and other 
reductions in out-of-pocket expenses and that such amounts shall be 
counted toward such deductible, co-insurance, co-payment, or limit, 
respectively.''.
    (b) Conforming Amendments.--
            (1) PPACA.--Section 1302(c)(3) of the Patient Protection 
        and Affordable Care Act (42 U.S.C. 18022(c)(3)) is amended by 
        adding at the end the following new subparagraph:
                    ``(C) Application of terms.--For purposes of 
                subparagraph (A), the terms `deductible', 
                `coinsurance', `copayment', or `similar charge' and any 
                other expenditure described in clause (ii) of such 
                subparagraph shall include amounts paid by, or on 
                behalf of, an individual enrolled in a group health 
                plan or group or individual health insurance coverage, 
                including third-party payments, financial assistance, 
                discounts, product vouchers, and other reductions in 
                out-of-pocket expenses and such amounts shall be 
                counted toward such deductible, coinsurance, copayment, 
                charge, or other expenditure, respectively.''.
            (2) PHSA.--Section 2707(b) of the Public Health Service Act 
        (42 U.S.C. 300gg-6(b)) is amended by adding at the end the 
        following new sentence: ``For purposes of the previous 
        sentence, such limitation shall be applied as if the reference 
        to `essential health benefits' in section 1302(c)(3) of the 
        Patient Protection and Affordable Care Act were a reference to 
        `any item or service covered under the plan included within a 
        category of essential health benefits as described in (b)(1) of 
        such section'.''.
                                 &lt;all&gt;
</pre></body></html>