AB 103

Health insurance policies and plans often apply deductibles and out-of-pocket

maximum amounts to the benefits covered by the policy or plan. A deductible is an

amount that an enrollee in a policy or plan must pay out of pocket before attaining

the full benefits of the policy or plan. An out-of-pocket maximum amount is a limit

specified by a policy or plan on the amount that an enrollee pays, and, once that limit

is reached, the policy or plan covers the benefit entirely. This bill generally requires

health insurance policies that offer prescription drug benefits, self-insured health

plans, and pharmacy benefit managers acting on behalf of policies or plans to apply

amounts paid by or on behalf of an individual covered under the policy or plan for

brand name prescription drugs to any cost-sharing requirement or to any

calculation of an out-of-pocket maximum amount of the policy or plan. Health

insurance policies are referred to in the bill as disability insurance policies.