This bill mandates that health carriers and pharmacy benefit managers must include any amounts paid by health benefit plan enrollees, or by others on their behalf, when calculating the enrollees' contributions towards out-of-pocket maximums or cost-sharing requirements. This requirement applies to health benefit plans that are entered into, amended, extended, or renewed on or after January 1, 2026. The bill defines key terms such as "cost-sharing requirement," "health benefit plan," "health carrier," "person," and "pharmacy benefit manager" to clarify the scope of the legislation.

Additionally, the bill includes a provision that if the inclusion of these payments would make a health savings account ineligible under the Internal Revenue Code, the requirement will only apply after the enrollee has met the minimum deductible. However, for preventive care services, this requirement will apply regardless of whether the minimum deductible has been satisfied. This ensures that enrollees can still benefit from preventive care without facing additional financial barriers.