Bill > H0219

This bill adds a new section to Idaho law that establishes rules for how health insurers calculate cost-sharing requirements for enrollees. Specifically, when determining an individual's contribution toward a health care service's cost-sharing (such as copayments, coinsurance, or deductibles), insurers must include amounts paid both directly by the enrollee and on the enrollee's behalf by other parties. The bill defines "health care service" broadly to include items or services aimed at preventing, treating, or healing human illness, injury, or disability, and covers prescription drugs. The law will apply to health benefit plans entered into, amended, extended, or renewed on or after January 1, 2026. There is an important exception for prescription drugs: if a generic equivalent exists and the patient's doctor confirms it is medically appropriate, the new cost-sharing calculation rules will not apply. The Idaho Department of Insurance is authorized to create rules to implement this legislation, subject to legislative approval. The bill is set to go into full effect on July 1, 2025, with an emergency clause highlighting its immediate importance.

Health and Social Services

Health and Welfare Committee (H)

https://legislature.idaho.gov/sessioninfo/2025/legislation/H0219/