(a)(1) In this section, “cost–sharing” means any expenditure required by or on behalf of an insured individual with respect to essential health benefits.
(2)“Cost–sharing” includes:
(i)deductibles, coinsurance, copayments, or similar charges; and
(ii)any other expenditure required of an insured individual that is a qualified medical expense, as defined in 26 U.S.C. § 223(d)(2), with respect to essential health benefits covered under the plan. (3)“Cost–sharing” does not include premiums, balance billing amounts for nonnetwork providers, or spending for noncovered services.
(b)(1) Except as provided in paragraph (2) of this subsection, each carrier shall comply with annual limitations on cost–sharing for essential
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(a) (1) In this section, “cost–sharing” means any expenditure required by or on behalf of an insured individual with respect to essential health benefits.
(2) “Cost–sharing” includes:
(i) deductibles, coinsurance, copayments, or similar charges; and
(ii) any other expenditure required of an insured individual that is a qualified medical expense, as defined in 26 U.S.C. § 223(d)(2), with respect to essential health benefits covered under the plan.
(3) “Cost–sharing” does not include premiums, balance billing amounts for nonnetwork providers, or spending for noncovered services.
(b) (1) Except as provided in paragraph (2) of this subsection, each carrier shall comply with annual limitations on cost–sharing for essential health benefits covered under health benefit plans as established by 45 C.F.R. § 156.130.
(2) If the Commissioner adopts regulations as described in subsection (c) of this section, each carrier shall comply with the adopted regulations.
(c) To the extent necessary, the Commissioner shall adopt regulations that:
(1) establish annual limitations on cost–sharing; and
(2) are consistent with 45 C.F.R. § 156.130 and any corresponding federal rules and guidance as those provisions were in effect December 31, 2024.