Bill > H0529

This bill establishes new provisions for out-of-pocket health care payments in Idaho, allowing individuals with health insurance, referred to as "covered persons," to pay a discounted cash price directly to a "health care provider" (like a doctor or hospital) for services instead of going through their "health carrier" (insurance company). Importantly, if a covered person negotiates a lower price than their plan's average allowed amount for a medically necessary service and pays it out-of-pocket, that payment will count towards their deductible and annual out-of-pocket maximum, provided they submit specific documentation to their health carrier, including proof of payment and confirmation that the provider is not billing the carrier. Health care providers are prohibited from billing the patient or carrier for any remaining balance after accepting the discounted cash payment. These provisions apply to most health benefit plans but have specific exclusions for certain types of insurance like dental, vision, accident-only, disability income, and Medicare supplemental policies, as well as programs like Medicaid and worker's compensation. The bill also declares an emergency and sets an effective date of July 1, 2026.

Business and Industry

Health and Welfare Committee (House)

https://legislature.idaho.gov/sessioninfo/2026/legislation/H0529/