Bill > HB2540

This bill requires health insurance providers to credit direct payments made by enrollees to healthcare providers toward their plan's deductible and annual out-of-pocket expenses, under specific conditions. The credit applies when the healthcare item or service is medically necessary and covered under the enrollee's health benefit plan, the enrollee does not initially submit the claim to the insurer, and the amount paid is less than the average discounted rate for that service from an in-network provider. Insurers must establish a process for enrollees to submit claims for this credit, either by creating a specific documentation submission process or by requiring enrollees to use the insurer's existing claims processing system. The bill specifically excludes health maintenance organizations (HMOs) from these requirements and will apply to health benefit plans issued, renewed, or extended on or after the bill's effective date in 2025. The goal appears to be providing consumers with more flexibility and potential financial relief when paying for healthcare services directly.