HF 4225

02/26/26   REVISOR  SGS/EI  26-07419
This Document can be made available
in alternative formats upon request  State of Minnesota
  HOUSE OF REPRESENTATIVES
  NINETY-FOURTH SESSION
  H. F. No.   4225
03/12/2026     Authored by Norris
  The bill was read for the first time and referred to the Committee on Commerce Finance and Policy
1.1A bill for an act
1.2relating to health insurance; limiting the amount a provider can charge an enrollee
1.3for denied covered services; proposing coding for new law in Minnesota Statutes,
1.4chapter 62Q.
1.5BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.6Section 1. [62Q.495] PAYMENT FOR DENIED COVERED SERVICES.
1.7(a) If a health plan company denies coverage, for procedural reasons, for a health care
1.8service that is a covered benefit under an enrollee's health plan, the provider may not charge
1.9the enrollee for the denied service more than the negotiated provider payment amount plus
1.1020 percent.
1.11(b) Any amount paid by the enrollee to a provider in accordance with paragraph (a) shall
1.12be counted toward any applicable deductible amount for which the enrollee is responsible
1.13under the enrollee's health plan.
1.14(c) Nothing in this section requires a health plan company to:
1.15(1) pay for services provided by an out-of-network provider unless required under the
1.16terms of the enrollee's health plan; or
1.17(2) provide coverage for services not covered under the enrollee's health plan.
1.18(d) For purposes of this section, "negotiated provider payment" means the payment the
1.19provider agrees to accept under the provider contract entered into by the provider and the
1.20health plan company for health care services provided by the provider to an enrollee covered
1.21by the health plan.
Section 1.  1