Adds to existing law to establish provisions regarding certain out-of-pocket payments for health care services.

LEGISLATURE OF THE STATE OF IDAHO Sixty-eighth Legislature Second Regular Session - 2026 IN THE HOUSE OF REPRESENTATIVES HOUSE BILL NO. 929 BY WAYS AND MEANS COMMITTEE AN ACT1 RELATING TO HEALTH CARE; AMENDING CHAPTER 18, TITLE 41, IDAHO CODE, BY THE2 ADDITION OF A NEW SECTION 41-1854, IDAHO CODE, TO DEFINE TERMS, TO PRO-3 VIDE FOR CERTAIN PROHIBITIONS AND DUTIES OF HEALTH CARRIERS AND HEALTH4 CARE PROVIDERS WITH REGARD TO CERTAIN COVERED PERSONS WHO PAY OUT OF5 POCKET FOR HEALTH CARE SERVICES; AND DECLARING AN EMERGENCY AND PROVID-6 ING AN EFFECTIVE DATE.7

Be It Enacted by the Legislature of the State of Idaho:8

SECTION 1. That Chapter 18, Title 41, Idaho Code, be, and the same is9 hereby amended by the addition thereto of a NEW SECTION, to be known and des-10 ignated as Section 41-1854, Idaho Code, and to read as follows:11 41-1854. HEALTH CARE -- CASH PRICE FOR SERVICES. (1) As used in this12 section, the terms "covered person," "health benefit plan," "health care13 provider," "health care services," "health carrier," and "medically nec-14 essary" shall have the same meanings as provided in section 41-5903, Idaho15 Code.16 (2) A health carrier may not prohibit a health care provider from of-17 fering a covered person the option of paying the provider's discounted cash18 price for health care services. For the purposes of this subsection, "dis-19 counted cash price" means the charge that applies to a covered person who20 pays cash for a health care service. With respect to a hospital, the dis-21 counted cash price shall have the same meaning as provided in 45 CFR 180.20 if22 the hospital has a discounted cash price. It does not mean the amount charged23 to individuals who are eligible for free care or are eligible for the amounts24 charged pursuant to a hospital's financial assistance policy.25 (3) A covered person may choose to pay out of pocket for a health care26 service from a health care provider.27 (4) If a covered person obtains a medically necessary health care ser-28 vice covered by such person's health benefit plan and negotiates for a price29 lower than the allowed amount established by the benefit plan, as provided30 to the covered person upon request, and the covered person pays out of pocket31 for the health care service, the amount of the out-of-pocket cost shall be32 counted toward the covered person's out-of-pocket deductible and annual33 maximum out-of-pocket expense if the requirements of this section are met.34 (5) A health carrier that receives the documentation described in35 subsection (6) of this section shall count the full amount that the cov-36 ered person paid out of pocket toward the deductible and annual maximum37 out-of-pocket expense if:38 (a) The health care service is covered under the health benefit plan of39 the covered person; and40

2 (b) The covered person negotiated for a lower cost for the health care1 service than the allowed amount established by the covered person's2 health benefit plan for that covered health care service.3 (6) A covered person shall electronically send documentation to the4 health carrier that provides the following information:5 (a) The health care services the covered person or patient received and6 the name of the health care provider and contact information;7 (b) The final bill or statement for the health care services; and8 (c) The negotiated cost of the health care service that the covered per-9 son received and documentation that:10 (i) The covered person paid out of pocket for the health care ser-11 vices received; and12 (ii) The health care provider is not making a claim against the13 health carrier for payment of the health care service provided to14 the covered person or patient.15 (7) The health care provider shall accept the discounted cash payment16 from the covered person as payment in full and shall not bill the covered per-17 son or the health carrier for any balance between the amount collected from18 the covered person and the billed charge for the service by the provider.19 (8) The amount of the out-of-pocket cost shall be attributed to the20 in-network deductible and annual maximum out-of-pocket expense if the21 provider was an in-network provider and to the out-of-network deductible and22 annual maximum out-of-pocket expense if the provider was an out-of-network23 provider.24 (9) The amount counted toward an applicable out-of-pocket deductible25 and annual maximum out-of-pocket expense shall not exceed the total amount26 that the covered person is required to pay out of pocket during a contractu-27 ally agreed on period of time for health care services that are included un-28 der the health benefit plan of the covered person and shall not carry over29 once a new contract or agreement period for the plan begins.30 (10) The provisions of subsections (4) through (9) of this section shall31 not apply to:32 (a) A plan that provides coverage:33 (i) Only for a specified disease or diseases;34 (ii) Only for accidental death or dismemberment;35 (iii) Only for dental or vision care;36 (iv) Under an individual limited benefit policy;37 (v) For a hospital confinement indemnity policy;38 (vi) For disability income insurance or a combination of acci-39 dent-only and disability income insurance; or40 (vii) As a supplement to liability insurance;41 (b) Any programs administered by the Idaho department of health and42 welfare through the state medicaid program under title XIX of the fed-43 eral social security act, as amended;44 (c) A medicare supplemental policy as defined by section 1882(g)(1) of45 the social security act;46 (d) Worker's compensation insurance coverage;47 (e) Medical payment insurance issued as part of a motor vehicle insur-48 ance policy;49

3 (f) A long-term care policy, including a nursing home fixed indemnity1 policy, unless a determination is made that the policy provides bene-2 fit coverage so comprehensive that the policy meets the definition of a3 health benefit plan; or4 (g) Short-term health insurance issued on a nonrenewable basis with a5 duration of six (6) months or less.6 (11) Nothing in this section shall be construed to waive or override7 prior authorization, medical necessity, or utilization management require-8 ments under the health benefit plan.9

SECTION 2. An emergency existing therefor, which emergency is hereby10 declared to exist, this act shall be in full force and effect on and after11 January 1, 2027.12