Senate Ins Agenda May 13 2026: calculating Rx co-pays for HSA HDHP and MI health plan out of pocket maximums

Background analysis by Senate Fiscal Agency, modified slightly for readable format.

https://legislature.mi.gov/documents/2025-2026/billanalysis/Senate/pdf/2026-SFA-0914-G.pdf

CALC. INSURANCE CO-PAY; PRESCRIPTION DRUGS S.B. 914:
SUMMARY OF INTRODUCED BILL
IN COMMITTEE

Senate Bill 914 (as introduced 4-22-26)
Sponsor: Senator Stephanie Chang

Committee: Finance, Insurance, and Consumer Protection
Date Completed: 5-12-25

CONTENT
The bill would amend Chapter 34 (Disability Insurance Policies) of the Insurance
Code to do the following:
-- Require a health insurance plan that provided coverage for prescription drugs to
count any money paid by the enrollee toward that enrollee's out-of-pocket and
maximum cost sharing requirements.
-- Specify that, if the application of that payment made ineligible an enrollee with
a high-deductible health plan (HDHP) with a Health Savings Account (HSA), the
payment would have to apply after the enrollee's minimum deductible was met.
-- Require payments made under an HDHP for preventative care to be applied when
calculating the insured's overall contribution to any out-of-pocket maximum or
any cost-sharing requirement regardless of whether the minimum deductible
had been satisfied.
Under the bill, a health insurance policy that provided coverage for prescription drugs that
was not an HDHP would have to include any amount paid by the enrollee or paid on behalf of
the enrollee by another person when calculating the insured's overall contribution to any outof-pocket maximum or any cost-sharing requirement.
"Prescription drug" would mean a drug that is dispensed pursuant to a prescription, bears the
Federal legend "CAUTION: Federal law prohibits dispensing without prescription" or "Rx only",
or is designated by the Michigan Board of Pharmacy as a drug that may only be dispensed
pursuant to a prescription. The term would not include a drug with AB-rated generic equivalent
unless the insured obtained access to the drug through period authorization, a step therapy
protocol, or the insurer's exception process.
"Cost sharing requirement" would mean any copayment, coinsurance, deductible, or annual
limitation on cost sharing including a limitation under Federal Law, required by or on behalf
of an insured in order to receive a specific health care service including a prescription drug,
covered by a health insurance policy.1
A health insurance policy that provided coverage for prescription drugs that was an HDHP
would have to include any amount paid by the enrollee or paid on behalf of the enrollee by
another person when calculating the insured's overall contribution to any out-of-pocket
maximum or any cost-sharing requirement. The bill specifies that if the application of payment
by the enrollee or on behalf of the enrollee would cause the enrollee's HSA to be considered
ineligible under Federal Law, the health insurance policy would have to apply the payment
after the HSA's minimum deductible had been satisfied.2 The health insurance plan would
have to apply the payment described above for payment of preventive care regardless of
whether the minimum deductible had been satisfied.
The bill would apply to a health insurance policy delivered, issued for delivery, or renewed in
the State after December 31, 2025. The provisions described above would be subject to
Section 4 of the Health Care False Claims Act, which prescribes a felony penalty punishable
by up to four years' imprisonment or a fine of up to $50,000, or both, for soliciting, offering
to pay, or receiving a kickback or bribe related to providing health care goods or services that
are paid for by a health care insurer or health care corporation or for receiving a rebate or fee
in exchange for referring a patient for health care services. Additionally, Federal law would
prevail if any of the bill's provisions conflicted with Federal law.

Proposed MCL 500.3406nn

PREVIOUS LEGISLATION
(This section does not provide a comprehensive account of previous legislative efforts on this subject matter.)
The bill is a reintroduction of House Bill 4719 of the 2023-2024 Legislative Session.
Legislative Analyst: Eleni Lionas

FISCAL IMPACT
The bill would have no fiscal impact on State or local government.
Fiscal Analyst: Nathan Leaman

Footnotes:

1 Section 42 USC 18022(c), sets Federal limits on annual cost sharing, for 2026 the limits are $10,600
for self-only coverage and $21,000 for family coverage. Additionally, 42 USC 300gg-6(b) requires group
health plans to not exceed those limits.

2 Section 223 of the Internal Revenue Code governs the use of HSAs by certain individuals who are
covered by HDHPs. Generally, outside of preventative care, a HDHP may not provide benefits until the
individual's HSA minimum deductible has been met. For calendar year 2026, an HDHP may have an
annual deductible that is at least $1,700 for self-only coverage and $3,400 for family coverage for which
annual out of pocket expenses including deductibles and co-pays do not exceed $8,500 for individuals
and $17,000 for families. Additionally, the annual limitation on HSA deductions for an individual and
families under an HDHP is $4,400 and $8,750, respectively.

SAS\S2526\s914sa
This analysis was prepared by nonpartisan Senate staff for use by the Senate in its deliberations and does not constitute an official
statement of legislative intent.