Bill > H0929

This bill establishes new rules for how out-of-pocket payments for healthcare services are handled, particularly when a patient pays directly to a healthcare provider. It clarifies that a health carrier, which is an insurance company or similar entity, cannot prevent a healthcare provider from offering a "discounted cash price" to a patient who chooses to pay upfront. This discounted cash price is simply the lower charge a provider offers to patients paying without insurance. The bill also states that if a patient pays out-of-pocket for a medically necessary service that is covered by their health benefit plan (a type of insurance plan), and they negotiated a lower price than what their plan would normally pay, that out-of-pocket amount must be counted towards their deductible and annual out-of-pocket maximum, provided certain conditions are met. To ensure this happens, the patient must submit documentation to their health carrier showing the services received, the final bill, the negotiated cost, proof of out-of-pocket payment, and confirmation that the provider is not seeking payment from the carrier. The healthcare provider must accept the discounted cash payment as full payment and cannot bill the patient or carrier for any remaining balance. These provisions apply to both in-network and out-of-network providers and are subject to the plan's contract period. However, these rules do not apply to certain types of insurance plans, such as those for specific diseases, dental or vision care, accident-only coverage, or Medicare supplemental policies, nor do they apply to programs like Medicaid or worker's compensation. The bill also includes an emergency clause, making it effective on January 1, 2027.

Business and Industry

Ways and Means Committee (House)

https://legislature.idaho.gov/sessioninfo/2026/legislation/H0929/