The proposed bill aims to amend the North Dakota Century Code by creating a new section related to out-of-pocket expenses for prescription drugs and updating existing provisions regarding self-insurance health care plans. Specifically, it introduces definitions for terms such as "cost-sharing," "enrollee," "health benefit plan," and "prescription drug." The bill stipulates that health benefit plans providing prescription drug coverage must include amounts paid by enrollees towards their out-of-pocket maximums and cost-sharing requirements. Additionally, it clarifies that if the application of this section would make a health benefit plan ineligible as a qualified high-deductible health plan, the requirements will not apply until the enrollee meets the minimum deductible.

Furthermore, the bill amends section 26.1-36.6-03 to ensure that various policy provisions apply to self-insurance health plans and are subject to the jurisdiction of the commissioner. It specifies that the new section regarding out-of-pocket expenses for prescription drugs will also apply to self-insurance health plans. The bill is set to take effect on January 1, 2026, and will apply to the public employees retirement system uniform group insurance program health insurance benefits coverage, as well as to health benefit plans upon their next renewal after this date.

Statutes affected:
INTRODUCED: 26.1-36.6-03
Adopted by the House Industry, Business and Labor Committee: 26.1-36.6-03
Adopted by the Senate Human Services Committee: 26.1-36.6-03
Prepared by the Legislative Council staff for Representative Karls: 26.1-36.6-03
FIRST ENGROSSMENT: 26.1-36.6-03