The "Ensuring Fairness in Cost-Sharing Amounts Act of 2024" mandates that health insurance carriers and pharmacy benefits managers in New Jersey must apply third-party discounts and payments towards an individual's copayments, coinsurance, deductibles, or other out-of-pocket costs for covered health benefits. This legislation aims to prevent the use of accumulators, which previously allowed insurers to disregard third-party assistance when calculating an insured's financial responsibility. The bill specifies that when determining a covered person's cost-sharing obligations, any discounts or payments made by third parties must be credited, particularly in the context of high-deductible health plans, in accordance with federal law.

Additionally, the bill amends existing regulations governing pharmacy benefits managers to broaden the scope of their services and redefine what constitutes cost-sharing. It includes new definitions for terms such as "carrier," "cost-sharing amount," and "health care service," while also requiring annual compliance certifications from carriers and pharmacy benefits managers to the Commissioner of Banking and Insurance. The bill is set to take effect on January 1, 2025, aligning New Jersey with other states that have enacted similar protections for consumers regarding health care costs.

Statutes affected:
Introduced: 17B:27F-1