H07132026 Regular Session

Adds to existing law to establish cost-sharing requirements for health benefit plans.

INSURANCE -- Adds to existing law to establish cost-sharing requirements for health benefit plans.

IntroducedIn CommitteeFloor VoteEnacted

STATEMENT OF PURPOSE

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This legislation would require health insurance companies to apply toward its insured's copay, deductible, and out-of-pocket maximum those payments which are made by a third party for the benefit of the insured.

FISCAL NOTE

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This legislation would cause no increase or decrease in revenue for the State of Idaho, or its subdivisions, nor would it result in additional expenditure of funds at the state or local levels of government, therefore, it would have no fiscal impact.

BILL TEXT

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LEGISLATURE OF THE STATE OF IDAHO Sixty-eighth Legislature Second Regular Session - 2026 IN THE HOUSE OF REPRESENTATIVES HOUSE BILL NO. 713 BY HEALTH AND WELFARE COMMITTEE AN ACT1 RELATING TO HEALTH INSURANCE; AMENDING CHAPTER 3, TITLE 41, IDAHO CODE, BY2 THE ADDITION OF A NEW SECTION 41-352, IDAHO CODE, TO ESTABLISH PROVI-3 SIONS REGARDING COST-SHARING REQUIREMENTS FOR HEALTH BENEFIT PLANS;4 AND DECLARING AN EMERGENCY AND PROVIDING AN EFFECTIVE DATE.5

Be It Enacted by the Legislature of the State of Idaho:6

SECTION 1. That Chapter 3, Title 41, Idaho Code, be, and the same is7 hereby amended by the addition thereto of a NEW SECTION, to be known and des-8 ignated as Section 41-352, Idaho Code, and to read as follows:9 41-352. COST-SHARING REQUIREMENTS FOR HEALTH BENEFIT PLANS. (1) As10 used in this section:11 (a) "Cost-sharing requirement" means any copayment, coinsurance, de-12 ductible, or annual limitation on cost-sharing required by a health13 benefit plan for a specific health care service covered by the health14 benefit plan and includes any copayment, coinsurance, deductible,15 or annual limitation subject to 42 U.S.C. 18022(c) or 42 U.S.C.16 300gg-6(b).17 (b) "Health care service" means an item or service furnished to an in-18 dividual for the purpose of preventing, alleviating, curing, or healing19 human illness, injury, or physical disability, including prescription20 drugs.21 (2) When calculating an enrollee's contribution to any applicable22 cost-sharing requirement for a health care service, an insurer shall include23 any cost-sharing amounts paid:24 (a) By the enrollee; or25 (b) On behalf of the enrollee by another party.26 (3) This section applies to any health benefit plan entered into,27 amended, extended, or renewed on or after January 1, 2027.28 (4) This section shall not apply to a health care service that is a pre-29 scription drug if:30 (a) There is a medically appropriate generic equivalent; and31 (b) The patient's doctor has indicated that the medically appropriate32 generic equivalent is appropriate for the patient.33 (5) The department of insurance may promulgate rules, subject to leg-34 islative approval, to carry out the provisions of this section.35

SECTION 2. An emergency existing therefor, which emergency is hereby36 declared to exist, this act shall be in full force and effect on and after37 July 1, 2026.38