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PURPOSE OF HB 1259
To create the Healthcare Cost-Sharing Collections Act.
ACTUARIAL STATEMENT
The Fiscal Impact Statement was prepared according to generally accepted actuarial principles and
practices, in compliance with ACT 112. The Statement provides an estimate of the financial and
actuarial effect of the proposed change(s) on the Plans, if possible. The Statement makes no
comment or opinion with regard to the merits of the measure for which the Statement is prepared;
however, any identified technical or mechanical defects have been noted.
We have reviewed the input and results of our analysis for reasonableness and relied upon the data
and information provided by the Plans and their Claims Processing Contractors.
3/10/2023
_________________________________________ _________________
Patrick Klein, FSA, MAAA Date
Vice President
3/10/2023
_________________________________________ __________________
Matthew Kersting, FSA, MAAA Date
Vice President
 PROJECTED COSTS
Estimated Cost as a Percentage
Annual Estimated Cost
Plan of Total Claims Spend
EBD $14,187,000 - $31,526,000 2.1% - 4.6%
UOA $2,624,000 - $5,831,000 1.7% - 3.7%
ASU $415,000 - $923,000 1.6% - 3.6%
UCA $154,000 - $341,000 1.2% - 2.7%
AHEC $101,000 - $225,000 1.5% - 3.4%
NWACC $60,000 - $133,000 1.9% - 4.3%
SAU $56,000 - $123,000 1.3% - 2.8%
PRICING APPROACH AND COMMENTS
House Bill 1259 establishes the Healthcare Cost Sharing Collections Act. This act mandates that
a healthcare insurer will pay a healthcare provider the full amount due for healthcare services under
the terms of a health benefit plan, including any cost sharing and have the sole responsibility for
collecting cost sharing from an enrollee. In addition, the enrollee is able to request to a cost sharing
collection plan with the healthcare insurer, where payments are made over time in increments.
Our understanding is that the healthcare insurer will pass on all financial liability accrued from
uncollected medical and pharmacy copays, coinsurance, and deductibles to the health benefit
plans. For the purposes of this analysis, EBD and the university systems would be impacted by
this legislation. We received actual historical member cost share data from the plans and applied
developed factors based on how much of the cost share is assumed to be uncollected. The
uncollected cost share factors were developed utilizing publicly available data and actuarial
judgement.
On the low end, it was assumed that 9% of the participant cost share goes uncollected, and on the
high end, 20% of the participant cost share goes uncollected. If the entire participant cost share is
collected, the legislation would have no impact on current health plan claim costs. If more of the
participant cost share goes uncollected, the impact on current health plan claim costs would be
greater. The factors used in our analysis are meant to be illustrative of the potential impact to the
health plans and likely to change over time from plan to plan, depending on various socio-economic
factors.
In our cost analysis presented above, there is no assumption for potential increase in utilization of
healthcare services due to the removal of participants having to pay their cost share at the time of
service. Having participants pay a cost share at a the time-of-service acts as potential financial
mechanism against participants seeking unnecessary care. Given the unknown potential for an
increase in utilization due to the removal of participant costs shares being paid at the time of service,
we cannot quantify this impact.
There is also no assumption in our provided cost estimates about the increased administrative costs
of having third party administrators and insurers collect cost shares from participants after services
have been rendered. The additional administrative cost is unknown but could be considerable given
the lack of current cost share collection mechanisms and the need for new teams to be developed
to handle the collection of cost shares from participants. If collection responsibility falls to the
employer, additional employees will likely need to be hired.