Bill > H0713

This bill establishes new rules for how health insurance plans, known as health benefit plans, calculate what patients have to pay out-of-pocket for covered medical services. Specifically, when determining if a patient has met their "cost-sharing requirement" – which includes things like copayments (a fixed amount paid for a service), coinsurance (a percentage of the cost paid), deductibles (the amount paid before insurance kicks in), and annual limits on these payments – insurance companies must count any money paid by the patient *or* on their behalf by someone else. This applies to health plans starting or renewed on or after January 1, 2027, but it does not apply to prescription drugs if a medically appropriate generic version is available and the patient's doctor agrees it's suitable. The Department of Insurance is authorized to create further rules to implement these provisions.

Health and Social Services

Health and Welfare Committee (House)

https://legislature.idaho.gov/sessioninfo/2026/legislation/H0713/