Prescription drugs; require that value of manufacturer copay assistance be applied to reduce patient deductible/out-of-pocket maximum costs.

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To: State Affairs
MISSISSIPPI LEGISLATURE REGULAR SESSION 2026

By: Representative Tullos

HOUSE BILL NO. 1667

AN ACT TO REQUIRE THAT HEALTH BENEFIT PLANS AND PRESCRIPTION 1
DRUG PROGRAMS THAT PROVIDE COVERAGE FOR PRESCRIPTION DRUGS AND 2
RECEIVE MANUFACTURER COPAY ASSISTANCE FOR A PRESCRIPTION DRUG MUST 3
APPLY THE VALUE OF THE COPAY ASSISTANCE TO REDUCE OR LIMIT THE 4
AMOUNT THAT A PATIENT PAYS FOR A PRESCRIPTION DRUG AND/OR APPLY 5
THE VALUE OF SUCH ASSISTANCE TO A PATIENT'S ANNUAL COST-SHARING 6
REQUIREMENTS, SUCH AS DEDUCTIBLES AND OUT-OF-POCKET MAXIMUM COSTS; 7
TO BRING FORWARD SECTIONS 83-9-5 AND 83-9-6.1, MISSISSIPPI CODE OF 8
1972, WHICH RELATE TO ACCIDENT AND HEALTH INSURANCE, FOR THE 9
PURPOSES OF POSSIBLE AMENDMENT; AND FOR RELATED PURPOSES. 10
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI: 11
SECTION 1. Every health benefit plan or prescription drug 12
program that provides coverage for prescription drugs and receives 13
manufacturer copay assistance for a prescription drug must apply 14
the value of the copay assistance to reduce or limit the amount 15
that a patient pays for such a prescription drug and/or apply the 16
value of such assistance to a patient's annual cost-sharing 17
requirements, such as deductibles and out-of-pocket maximum costs. 18
SECTION 2. Section 83-9-5, Mississippi Code of 1972, is 19
brought forward as follows: 20
83-9-5. (1) Required provisions. Except as provided in 21
subsection (3) of this section, each such policy delivered or 22
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issued for delivery to any person in this state shall contain the 23
provisions specified in this subsection in the words in which the 24
same appear in this section. However, the insurer may, at its 25
option, substitute for one or more of such provisions, 26
corresponding provisions of different wording approved by the 27
commissioner which are in each instance not less favorable in any 28
respect to the insured or the beneficiary. Such provisions shall 29
be preceded individually by the caption appearing in this 30
subsection or, at the option of the insurer, by such appropriate 31
individual or group captions or subcaptions as the commissioner 32
may approve. 33
As used in this section, the term "insurer" means a health 34
maintenance organization, an insurance company or any other entity 35
responsible for the payment of benefits under a policy or contract 36
of accident and sickness insurance; however, the term "insurer" 37
shall not mean a liquidator, rehabilitator, conservator or 38
receiver or third-party administrator of any health maintenance 39
organization, insurance company or other entity responsible for 40
the payment of benefits which is in liquidation, rehabilitation or 41
conservation proceedings, nor shall it mean any responsible 42
guaranty association. Further, no cause of action shall accrue 43
against a liquidator, rehabilitator, conservator or receiver or 44
third-party administrator of any health maintenance organization, 45
insurance company or other entity responsible for the payment of 46
benefits which is in liquidation, rehabilitation or conservation 47
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proceedings or any responsible guaranty association under 48
paragraph (h)3 of this subsection or any policy provision in 49
accordance therewith. 50
(a) A provision as follows: 51
Entire contract; changes: This policy, including the 52
endorsements and the attached papers, if any, constitutes the 53
entire contract of insurance. No change in this policy shall be 54
valid until approved by an executive officer of the insurer and 55
unless such approval be endorsed hereon or attached hereto. No 56
agent has authority to change this policy or to waive any of its 57
provisions. 58
(b) A provision as follows: 59
Time limit on certain defenses: 60
1. After two (2) years from the date of issue of 61
this policy, no misstatements, except fraudulent misstatements, 62
made by the applicant in the application for such policy shall be 63
used to void the policy or to deny a claim for loss incurred or 64
disability (as defined in the policy) commencing after the 65
expiration of such two-year period. 66
(The foregoing policy provision shall not be so construed as 67
to effect any legal requirement for avoidance of a policy or 68
denial of a claim during such initial two-year period, nor to 69
limit the application of subsection (2)(a) and (2)(b) of this 70
section in the event of misstatement with respect to age or 71
occupation.) 72
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(A policy which the insured has the right to continue in 73
force subject to its terms by the timely payment of premium (1) 74
until at least age fifty (50) or, (2) in the case of a policy 75
issued after age forty-four (44), for at least five (5) years from 76
its date of issue, may contain in lieu of the foregoing the 77
following provision (from which the clause in parentheses may be 78
omitted at the insurer's option) under the caption 79
"INCONTESTABLE": 80
After this policy has been in force for a period of two (2) 81
years during the lifetime of the insured (excluding any period 82
during which the insured is disabled), it shall become 83
incontestable as to the statements in the application.) 84
2. No claim for loss incurred or disability (as 85
defined in the policy) commencing after two (2) years from the 86
date of issue of this policy shall be reduced or denied on the 87
ground that a disease or physical condition not excluded from 88
coverage by name or specific description effective on the date of 89
loss had existed prior to the effective date of coverage of this 90
policy. 91
(c) A provision as follows: 92
Grace period: 93
A grace period of seven (7) days for weekly premium policies, 94
ten (10) days for monthly premium policies and thirty-one (31) 95
days for all other policies will be granted for the payment of 96
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each premium falling due after the first premium, during which 97
grace period the policy shall continue in force. 98
(A policy which contains a cancellation provision may add, at 99
the end of the above provision, "subject to the right of the 100
insurer to cancel in accordance with the cancellation provision 101
hereof." 102
A policy in which the insurer reserves the right to refuse 103
any renewal shall have, at the beginning of the above provision, 104
"unless not less than five (5) days prior to the premium due date 105
the insurer has delivered to the insured or has mailed to his last 106
address as shown by the records of the insurer written notice of 107
its intention not to renew this policy beyond the period for which 108
the premium has been accepted.") 109
(d) A provision as follows: 110
Reinstatement: 111
If any renewal premium be not paid within the time granted 112
the insured for payment, a subsequent acceptance of premium by the 113
insurer or by any agent duly authorized by the insurer to accept 114
such premium, without requiring in connection therewith an 115
application for reinstatement, shall reinstate the policy. 116
However, if the insurer or such agent requires an application for 117
reinstatement and issues a conditional receipt for the premium 118
tendered, the policy will be reinstated upon approval of such 119
application by the insurer or, lacking such approval, upon the 120
forty-fifth day following the date of such conditional receipt 121
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unless the insurer has previously notified the insured in writing 122
of its disapproval of such application. The reinstated policy 123
shall cover only loss resulting from such accidental injury as may 124
be sustained after the date of reinstatement and loss due to such 125
sickness as may begin more than ten (10) days after such date. In 126
all other respects the insured and insurer shall have the same 127
rights thereunder as they had under the policy immediately before 128
the due date of the defaulted premium, subject to any provisions 129
endorsed hereon or attached hereto in connection with the 130
reinstatement. Any premium accepted in connection with a 131
reinstatement shall be applied to a period for which premium has 132
not been previously paid, but not to any period more than sixty 133
(60) days prior to the date of reinstatement. (The last sentence 134
of the above provision may be omitted from any policy which the 135
insured has the right to continue in force subject to its terms by 136
the timely payment of premiums (1) until at least age fifty (50) 137
or, (2) in the case of a policy issued after age forty-four (44), 138
for at least five (5) years from its date of issue.) 139
(e) A provision as follows: 140
Notice of claim: 141
Written notice of claim must be given to the insurer within 142
thirty (30) days after the occurrence or commencement of any loss 143
covered by the policy, or as soon thereafter as is reasonably 144
possible. Notice given by or on behalf of the insured or the 145
beneficiary to the insurer at ________________ (insert the 146
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location of such office as the insurer may designate for the 147
purpose), or to any authorized agent of the insurer, with 148
information sufficient to identify the insured, shall be deemed 149
notice to the insurer. 150
(In a policy providing a loss of time benefit which may be 151
payable for at least two (2) years, an insurer may, at its option, 152
insert the following between the first and second sentences of the 153
above provision: "Subject to the qualifications set forth below, 154
if the insured suffers loss of time on account of disability for 155
which indemnity may be payable for at least two (2) years, he 156
shall, at least once in every six (6) months after having given 157
notice of claim, give to the insurer notice of continuance of said 158
disability, except in the event of legal incapacity. The period 159
of six (6) months following any filing of proof by the insured or 160
any payment by the insurer on account of such claim or any denial 161
of liability, in whole or in part, by the insurer shall be 162
excluded in applying this provision. Delay in the giving of such 163
notice shall not impair the insured's right to any indemnity which 164
would otherwise have accrued during the period of six (6) months 165
preceding the date on which such notice is actually given.") 166
(f) A provision as follows: 167
Claim forms: 168
The insurer, upon receipt of a notice of claim, will furnish 169
to the claimant such forms as are usually furnished by it for 170
filing proofs of loss. If such forms are not furnished within 171
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fifteen (15) days after the giving of such notice, the claimant 172
shall be deemed to have complied with the requirements of this 173
policy as to proof of loss upon submitting, within the time fixed 174
in the policy for filing proofs of loss, written proof covering 175
the occurrence, the character and the extent of the loss for which 176
claim is made. 177
(g) A provision as follows: 178
Proofs of loss: 179
Written proof of loss must be furnished to the insurer at its 180
said office, in case of claim for loss for which this policy 181
provides any periodic payment contingent upon continuing loss, 182
within ninety (90) days after the termination of the period for 183
which the insurer is liable, and in case of claim for any other 184
loss, within ninety (90) days after the date of such loss. 185
Failure to furnish such proof within the time required shall not 186
invalidate or reduce any claim if it was not reasonably possible 187
to give proof within such time, provided such proof is furnished 188
as soon as reasonably possible and in no event, except in the 189
absence of legal capacity, later than one (1) year from the time 190
proof is otherwise required. 191
(h) A provision as follows: 192
Time of payment of claims: 193
1. All benefits payable under this policy for any 194
loss, other than loss for which this policy provides any periodic 195
payment, will be paid within twenty-five (25) days after receipt 196
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of due written proof of such loss in the form of a clean claim 197
where claims are submitted electronically, and will be paid within 198
thirty-five (35) days after receipt of due written proof of such 199
loss in the form of clean claim where claims are submitted in 200
paper format. Benefits due under the policies and claims are 201
overdue if not paid within twenty-five (25) days or thirty-five 202
(35) days, whichever is applicable, after the insurer receives a 203
clean claim containing necessary medical information and other 204
information essential for the insurer to administer preexisting 205
condition, coordination of benefits and subrogation provisions. A 206
"clean claim" means a claim received by an insurer for 207
adjudication and which requires no further information, adjustment 208
or alteration by the provider of the services or the insured in 209
order to be processed and paid by the insurer. A claim is clean 210
if it has no defect or impropriety, including any lack of 211
substantiating documentation, or particular circumstance requiring 212
special treatment that prevents timely payment from being made on 213
the claim under this provision. A clean claim includes 214
resubmitted claims with previously identified deficiencies 215
corrected. Upon request, the insurer shall provide to the insured 216
or the provider submitting a claim a written list of the 217
information required and the documentation required for the 218
insurer to deem a claim to be clean, and the insurer shall then be 219
bound to such list. Errors, such as system errors, attributable 220
to the insurer, do not change the clean claim status. 221
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A clean claim does not include any of the following: 222
a. A duplicate claim, which means an original 223
claim and its duplicate when the duplicate is filed within thirty 224
(30) days of the original claim; 225
b. Claims which are submitted fraudulently or 226
that are based upon material misrepresentations; 227
c. Claims that require information essential 228
for the insurer to administer preexisting condition, coordination 229
of benefits or subrogation provisions; or 230
d. Claims submitted by a provider more than 231
thirty (30) days after the date of completion of service; if the 232
provider does not submit the claim on behalf of the insured, then 233
a claim is not clean when submitted more than thirty (30) days 234
after the date of billing by the provider to the insured. 235
Not later than twenty-five (25) days after the date the 236
insurer actually receives an electronic claim, the insurer shall 237
pay the appropriate benefit in full, or any portion of the claim 238
that is clean, and notify the provider (where the claim is owed to 239
the provider) or the insured (where the claim is owed to the 240
insured) of the reasons why the claim or portion thereof is not 241
clean and will not be paid and what substantiating documentation 242
and information is required to adjudicate the claim as clean. Not 243
later than thirty-five (35) days after the date the insurer 244
actually receives a paper claim, the insurer shall pay the 245
appropriate benefit in full, or any portion of the claim that is 246
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clean, and notify the provider (where the claim is owed to the 247
provider) or the insured (where the claim is owed to the insured) 248
of the reasons why the claim or portion thereof is not clean and 249
will not be paid and what substantiating documentation and 250
information is required to adjudicate the claim as clean. Any 251
claim or portion thereof resubmitted with the supporting 252
documentation and information requested by the insurer shall be 253
paid within twenty (20) days after receipt. 254
For purposes of this provision, the term "pay" means that the 255
insurer shall either send cash or a cash equivalent by United 256
States mail, or send cash or a cash equivalent by other means such 257
as electronic transfer, in full satisfaction of the appropriate 258
benefit due the provider (where the claim is owed to the provider) 259
or the insured (where the claim is owed to the insured). To 260
calculate the extent to which any benefits are overdue, payment 261
shall be treated as made on the date a draft or other valid 262
instrument was placed in the United States mail to the last known 263
address of the provider (where the claim is owed to the provider) 264
or the insured (where the claim is owed to the insured) in a 265
properly addressed, postpaid envelope, or, if not so posted, or 266
not sent by United States mail, on the date of delivery of payment 267
to the provider or insured. 268
2. Subject to due written proof of loss, all 269
accrued benefits for loss for which this policy provides periodic 270
payment will be paid _______________ (insert period for payment 271
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which must not be less frequently than monthly), and any balance 272
remaining unpaid upon the termination of liability will be paid 273
within thirty (30) days after receipt of due written proof. 274
3. If the claim is not denied for valid and proper 275
reasons by the end of the applicable time period prescribed in 276
this provision, the insurer must pay the provider (where the claim 277
is owed to the provider) or the insured (where the claim is owed 278
to the insured) interest on accrued benefits at the rate of three 279
percent (3%) per month accruing from the day after payment was due 280
on the amount of the benefits that remain unpaid until the claim 281
is finally settled or adjudicated. Whenever interest due pursuant 282
to this provision is less than One Dollar ($1.00), such amount 283
shall be credited to the account of the person or entity to whom 284
such amount is owed. The provisions of this subparagraph 3 shall 285
not apply to any claims or benefits owed under Medicare Advantage 286
plans or Medicare Advantage Prescription Drug plans. 287
4. In the event the insurer fails to pay benefits 288
when due, the person entitled to such benefits may bring action to 289
recover such benefits, any interest which may accrue as provided 290
in subparagraph 3 of this paragraph (h) and any other damages as 291
may be allowable by law. If it is determined in such action that 292
the insurer acted in bad faith as evidenced by a repeated or 293
deliberate pattern of failing to pay benefits and/or claims when 294
due, the person entitled to such benefits (health care provider or 295
insured) shall be entitled to recover damages in an amount up to 296
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three (3) times the amount of the benefits that remain unpaid 297
until the claim is finally settled or adjudicated. 298
(i) A provision as follows: 299
Payment of claims: 300
Indemnity for loss of life will be payable in accordance with 301
the beneficiary designation and the provisions respecting such 302
payment which may be prescribed herein and effective at the time 303
of payment. If no such designation or provision is then 304
effective, such indemnity shall be payable to the estate of the 305
insured. Any other accrued indemnities unpaid at the insured's 306
death may, at the option of the insurer, be paid either to such 307
beneficiary or to such estate. All other indemnities will be 308
payable to the insured. When payments of benefits are made to an 309
insured directly for medical care or services rendered by a health 310
care provider, the health care provider shall be notified of such 311
payment. The notification requirement shall not apply to a 312
fixed-indemnity policy, a limited benefit health insurance policy, 313
medical payment coverage or personal injury protection coverage in 314
a motor vehicle policy, coverage issued as a supplement to 315
liability insurance or workers' compensation. If the insured 316
provides the insurer with written direction that all or a portion 317
of any indemnities or benefits provided by the policy be paid to a 318
licensed health care provider rendering hospital, nursing, medical 319
or surgical services, then the insurer shall pay directly the 320
licensed health care provider rendering such services; provided, 321
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however, licensed health care provider shall not include those in 322
the practice of dentistry. That payment shall be considered 323
payment in full to the provider, who may not bill or collect from 324
the insured any amount above that payment, other than the 325
deductible, coinsurance, copayment or other charges for equipment 326
or services requested by the insured that are noncovered benefits. 327
Any dispute between a provider and the insured arising under these 328
provisions regarding assignment of benefits and billing may be 329
resolved by the Commissioner of Insurance. The Commissioner of 330
Insurance shall adopt any rules and regulations necessary to 331
enforce these provisions regarding assignment of benefits and 332
billing. 333
(The following provision may be included with the foregoing 334
provision at the option of the insurer: "If any indemnity of this 335
policy shall be payable to the estate of the insured, or to an 336
insured or beneficiary who is a minor or otherwise not competent 337
to give a valid release, the insurer may pay such indemnity, up to 338
an amount not exceeding $______________ (insert an amount which 339
must not exceed One Thousand Dollars ($1,000.00)), to any relative 340
by blood or connection by marriage of the insured or beneficiary 341
who is deemed by the insurer to be equitably entitled thereto. 342
Any payment made by the insurer in good faith pursuant to this 343
provision shall fully discharge the insurer to the extent of such 344
payment.") 345
(j) A provision as follows: 346
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Physical examinations: 347
The insurer at his own expense shall have the right and 348
opportunity to examine the person of the insured when and as often 349
as it may reasonably require during the pendency of a claim 350
hereunder. 351
(k) A provision as follows: 352
Legal actions: 353
No action at law or in equity shall be brought to recover on 354
this policy prior to the expiration of sixty (60) days after 355
written proof of loss has been furnished in accordance with the 356
requirements of this policy. No such action shall be brought 357
after the expiration of three (3) years after the time written 358
proof of loss is required to be furnished. 359
(l) A provision as follows: 360
Change of beneficiary: 361
Unless the insured makes an irrevocable designation of 362
beneficiary, the right to change the beneficiary is reserved to 363
the insured, and the consent of the beneficiary or beneficiaries 364
shall not be requisite to surrender or assignment of this policy, 365
or to any change of beneficiary or beneficiaries, or to any other 366
changes in this policy. 367
(The first clause of this provision, relating to the 368
irrevocable designation of beneficiary, may be omitted at the 369
insurer's option.) 370
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(2) Other provisions. Except as provided in subsection (3) 371
of this section, no such policy delivered or issued for delivery 372
to any person in this state shall contain provisions respecting 373
the matters set forth below unless such provisions are in the 374
words in which the same appear in this section. However, the 375
insurer may, at its option, use in lieu of any such provision a 376
corresponding provision of different wording approved by the 377
commissioner which is not less favorable in any respect to the 378
insured or the beneficiary. Any such provision contained in the 379
policy shall be preceded individually by the appropriate caption 380
appearing in this subsection or, at the option of the insurer, by 381
such appropriate individual or group captions or subcaptions as 382
the commissioner may approve. 383
(a) A provision as follows: 384
Change of occupation: 385
If the insured be injured or contract sickness after having 386
changed his occupation to one classified by the insurer as more 387
hazardous than that stated in this policy or while doing for 388
compensation anything pertaining to an occupation so classified, 389
the insurer will pay only such portion of the indemnities provided 390
in this policy as the premium paid would have purchased at the 391
rates and within the limits fixed by the insurer for such more 392
hazardous occupation. If the insured changes his occupation to 393
one classified by the insurer as less hazardous than that stated 394
in this policy, the insurer, upon receipt of proof of such change 395
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of occupation, will reduce the premium rate accordingly, and will 396
return the excess pro rata unearned premium from the date of 397
change of occupation or from the policy anniversary date 398
immediately preceding receipt of such proof, whichever is the most 399
recent. In applying this provision, the classification of 400
occupational risk and the premium rates shall be such as have been 401
last filed by the insurer prior to the occurrence of the loss for 402
which the insurer is liable, or prior to date of proof of change 403
in occupation, with the state official having supervision of 404
insurance in the state where the insured resided at the time this 405
policy was issued; but if such filing was not required, then the 406
classification of occupational risk and the premium rates shall be 407
those last made effective by the insurer in such state prior to 408
the occurrence of the loss or prior to the date of proof of change 409
in occupation. 410
(b) A provision as follows: 411
Misstatement of age: 412
If the age of the insured has been misstated, all amounts 413
payable under this policy shall be such as the premium paid would 414
have purchased at the correct age. 415
(c) A provision as follows: 416
Relation of earnings to issuance: 417
If the total monthly amount of loss of time benefits promised 418
for the same loss under all valid loss of time coverage upon the 419
insured, whether payable on a weekly or monthly basis, shall 420
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exceed the monthly earnings of the insured at the time disability 421
commenced or his average monthly earnings for the period of two 422
(2) years immediately preceding a disability for which claim is 423
made, whichever is the greater, the insurer will be liable only 424
for such proportionate amount of such benefits under this policy 425
as the amount of such monthly earnings or such average monthly 426
earnings of the insured bears to the total amount of monthly 427
benefits for the same loss under all such coverage upon the 428
insured at the time such disability commences and for the return 429
of such part of the premiums paid during such two (2) years as 430
shall exceed the pro rata amount of the premiums for the benefits 431
actually paid hereunder; but this shall not operate to reduce the 432
total monthly amount of benefits payable under all such coverage 433
upon the insured below the sum of Two Hundred Dollars ($200.00) or 434
the sum of the monthly benefits specified in such coverages, 435
whichever is the lesser, nor shall it operate to reduce benefits 436
other than those payable for loss of time. 437
(The foregoing policy provision may be inserted only in a 438
policy which the insured has the right to continue in force 439
subject to its terms by the timely payment of premiums (1) until 440
at least age fifty (50) or, (2) in the case of a policy issued 441
after age forty-four (44), for at least five (5) years from its 442
date of issue. The insurer may, at its option, include in this 443
provision a definition of "valid loss of time coverage," approved 444
as to form by the commissioner, which definition shall be limited 445
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in subject matter to coverage provided by governmental agencies or 446
by organizations subject to regulations by insurance law or by 447
insurance authorities of this or any other state of the United 448
States or any province of Canada, or to any other coverage the 449
inclusion of which may be approved by the commissioner, or any 450
combination of such coverages. In the absence of such definition, 451
such term shall not include any coverage provided for such insured 452
pursuant to any compulsory benefit statute (including any workers' 453
compensation or employer's liability statute), or benefits 454
provided by union welfare plans or by employer or employee benefit 455
organizations.) 456
(d) A provision as follows: 457
Unpaid premium: 458
Upon the payment of a claim under this policy, any premium 459
then due and unpaid or covered by any note or written order may be 460
deducted therefrom. 461
(e) A provision as follows: 462
Cancellation: 463
The insurer may cancel this policy at any time by written 464
notice delivered to the insured, or mailed to his last address as 465
shown by the records of the insurer, stating when, not less than 466
five (5) days thereafter, such cancellation shall be effective; 467
and after the policy has been continued beyond its original term, 468
the insured may cancel this policy at any time by written notice 469
delivered or mailed to the insurer, effective upon receipt or on 470
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such later date as may be specified in such notice. In the event 471
of cancellation, the insurer will return promptly the unearned 472
portion of any premium paid. If the insured cancels, the earned 473
premium shall be computed by the use of the short-rate table last 474
filed with the state official having supervision of insurance in 475
the state where the insured resided when the policy was issued. 476
If the insurer cancels, the earned premium shall be computed pro 477
rata. Cancellation shall be without prejudice to any claim 478
originating prior to the effective date of cancellation. 479
(f) A provision as follows: 480
Conformity with state statutes: 481
Any provision of this policy which, on its effective date, is 482
in conflict with the statutes of the state in which the insured 483
resides on such date is hereby amended to conform to the minimum 484
requirements of such statutes. 485
(g) A provision as follows: 486
Illegal occupation: 487
The insurer shall not be liable for any loss to which a 488
contributing cause was the insured's commission of or attempt to 489
commit a felony or to which a contributing cause was the insured's 490
being engaged in an illegal occupation. 491
(h) A provision as follows: 492
Intoxicants and narcotics: 493
The insurer shall not be liable for any loss sustained or 494
contracted in consequence of the insured's being intoxicated or 495
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under the influence of any narcotic unless administered on the 496
advice of a physician. 497
(3) Inapplicable or inconsistent provisions. If any 498
provision of this section is, in whole or in part, inapplicable to 499
or inconsistent with the coverage provided by a particular form of 500
policy, the insurer, with the approval of the commissioner, shall 501
omit from such policy any inapplicable provision or part of a 502
provision, and shall modify any inconsistent provision or part of 503
the provision in such manner as to make the provision as contained 504
in the policy consistent with the coverage provided by the policy. 505
(4) Order of certain policy provisions. The provisions 506
which are the subject of subsections (1) and (2) of this section, 507
or any corresponding provisions which are used in lieu thereof in 508
accordance with such subsections, shall be printed in the 509
consecutive order of the provisions in such subsections or, at the 510
option of the insurer, any such provision may appear as a unit in 511
any part of the policy, with other provisions to which it may be 512
logically related, provided the resulting policy shall not be, in 513
whole or in part, unintelligible, uncertain, ambiguous, abstruse 514
or likely to mislead a person to whom the policy is offered, 515
delivered or issued. 516
(5) Third-party ownership. The word "insured," as used in 517
Sections 83-9-1 through 83-9-21, Mississippi Code of 1972, shall 518
not be construed as preventing a person other than the insured 519
with a proper insurable interest from making application for and 520
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owning a policy covering the insured, or from being entitled under 521
such a policy to any indemnities, benefits and rights provided 522
therein. 523
(6) Requirements of other jurisdictions. 524
(a) Any policy of a foreign or alien insurer, when 525
delivered or issued for delivery to any person in this state, may 526
contain any provision which is not less favorable to the insured 527
or the beneficiary than the provisions of Sections 83-9-1 through 528
83-9-21, Mississippi Code of 1972, and which is prescribed or 529
required by the law of the state under which the insurer is 530
organized. 531
(b) Any policy of a domestic insurer may, when issued 532
for delivery in any other state or country, contain any provision 533
permitted or required by the laws of such other state or country. 534
(7) Filing procedure. The commissioner may make such 535
reasonable rules and regulations concerning the procedure for the 536
filing or submission of policies subject to the cited sections as 537
are necessary, proper or advisable to the administration of said 538
sections. This provision shall not abridge any other authority 539
granted the commissioner by law. 540
(8) Administrative penalties. 541
(a) If the commissioner finds that an insurer, during 542
any calendar year, has paid at least eighty-five percent (85%), 543
but less than ninety-five percent (95%), of all clean claims 544
received from all providers during that year in accordance with 545
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the provisions of subsection (1)(h) of this section, the 546
commissioner may levy an aggregate penalty in an amount not to 547
exceed Ten Thousand Dollars ($10,000.00). If the commissioner 548
finds that an insurer, during any calendar year, has paid at least 549
fifty percent (50%), but less than eighty-five percent (85%), of 550
all clean claims received from all providers during that year in 551
accordance with the provisions of subsection (1)(h) of this 552
section, the commissioner may levy an aggregate penalty in an 553
amount of not less than Ten Thousand Dollars ($10,000.00) nor more 554
than One Hundred Thousand Dollars ($100,000.00). If the 555
commissioner finds that an insurer, during any calendar year, has 556
paid less than fifty percent (50%) of all clean claims received 557
from all providers during that year in accordance with the 558
provisions of subsection (1)(h) of this section, the commissioner 559
may levy an aggregate penalty in an amount not less than One 560
Hundred Thousand Dollars ($100,000.00) nor more than Two Hundred 561
Thousand Dollars ($200,000.00). In determining the amount of any 562
fine, the commissioner shall take into account whether the failure 563
to achieve the standards in subsection (1)(h) of this section were 564
due to circumstances beyond the control of the insurer. The 565
insurer may request an administrative hearing to contest the 566
assessment of any administrative penalty imposed by the 567
commissioner pursuant to this subsection within thirty (30) days 568
after receipt of the notice of assessment. 569
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(b) Examinations to determine compliance with 570
subsection (1)(h) of this section may be conducted by the 571
commissioner or any of his examiners. The commissioner may 572
contract with qualified impartial outside sources to assist in 573
examinations to determine compliance. The expenses of any such 574
examinations shall be paid by the insurer examined. 575
(c) Nothing in the provisions of subsection (1)(h) of 576
this section shall require an insurer to pay claims that are not 577
covered under the terms of a contract or policy of accident and 578
sickness insurance. 579
(d) An insurer and a provider may enter into an express 580
written agreement containing timely claim payment provisions which 581
differ from, but are at least as stringent as, the provisions set 582
forth under subsection (1)(h) of this section, and in such case, 583
the provisions of the written agreement shall govern the timely 584
payment of claims by the insurer to the provider. Any such 585
written agreement shall contain a provision that the insurer shall 586
provide to the insured or the provider submitting a claim a 587
written list of the information required and the documentation 588
required for the insurer to deem a claim to be clean, and the 589
insurer shall then be bound to such list. If the express written 590
agreement is silent as to any interest penalty where claims are 591
not paid in accordance with the agreement, the interest penalty 592
provision of subsection (1)(h)3 of this section shall apply. The 593
commissioner shall have jurisdiction and authority to ensure any 594
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written agreement complies with the foregoing requirements. 595
Further, the commissioner shall have jurisdiction and authority to 596
apply the Administrative Penalties set forth in subsection (8) of 597
this section to the written agreement. 598
(e) The commissioner may adopt rules and regulations 599
necessary to ensure compliance with this subsection. 600
(9) The commissioner may adopt rules and regulations 601
necessary to ensure compliance with the provisions of this 602
section. 603
SECTION 3. Section 83-9-6.1, Mississippi Code of 1972, is 604
brought forward as follows: 605
83-9-6.1. (1) As used in this section: 606
(a) "Cash discount card" means a card, other than the 607
program identification card of a member or participant of a 608
prescription drug program, that allows the holder to obtain a 609
discount on a prescription drug when paying for the prescription 610
at the point-of-sale. 611
(b) "Prescription drug program" means a program or plan 612
that provides coverages and benefits for prescription drugs for 613
members or participants in the program, whether the program is a 614
separate program or part of a health benefit plan. 615
(2) Any entity that administers a prescription drug program 616
through a network of participating pharmacies for the benefit of 617
any resident of the State of Mississippi shall not issue or 618
distribute any cash discount card that the participating 619
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ST: Prescription drugs; require that value of
manufacturer copay assistance be applied to
reduce patient deductible/out-of-pocket maximum
costs.
pharmacies must accept or honor as a condition or requirement of 620
participation in the prescription drug program, or that the 621
participating pharmacies must accept or honor if they accept or 622
honor program identification cards held by members or participants 623
of any prescription drug program administered by the entity, 624
unless the entity pays a portion of the cost of the discount given 625
by the pharmacy for prescriptions purchased with the use of the 626
cash discount card. 627
(3) Any person or entity that is not subject to subsection 628
(2) of this section shall not issue or distribute any cash 629
discount card to any resident of the State of Mississippi unless 630
the person or entity pays a portion of the cost of the discount 631
given by the pharmacy for prescriptions purchased with the use of 632
the cash discount card. 633
(4) Any provision in any prescription drug program or health 634
benefit plan that is executed, delivered, renewed or otherwise 635
contracted for in this state that is not in compliance with this 636
section shall be void to the extent of the noncompliance. 637
(5) The provisions of this section shall not apply to the 638
issuers of Medicare Supplement Insurance policies. 639
(6) The Office of Attorney General, Consumer Protection 640
Division, shall enforce the provisions of this section. 641
SECTION 4. This act shall take effect and be in force from 642
and after July 1, 2026. 643