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Bill

H 219

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

68th Legislature, 1st Regular Session (2025)

House Bill 219 requires health insurers to include third-party payments in cost-sharing calculations, reducing out-of-pocket costs for insured individuals starting January 1, 2026.

Reported Printed and Referred to Health & Welfare
#health #healthcareprofessionsandproviders #insurance #medical
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Bill Summary · H 219

Summary of House Bill 219 (H 219)

Bill Overview

  • Title: INSURANCE – Adds to existing law to establish cost-sharing requirements for health benefit plans.
  • Bill Number: H 219
  • Introduced: February 12, 2025
  • Status: Reported Printed and Referred to Health & Welfare
  • Classification: Bill
  • Subject Areas: Health, Health Care Professions and Providers, Insurance, Medical

Purpose and Intent

House Bill 219 aims to enhance the transparency and fairness of health insurance cost-sharing requirements. Specifically, the bill mandates that health insurance companies account for third-party payments when calculating an insured individual's copay, deductible, and out-of-pocket maximum. This is intended to ensure that insured individuals receive full credit for any payments made on their behalf, thereby reducing their financial burden.

Key Provisions

The bill introduces a new section (41-351) to Chapter 3, Title 41 of the Idaho Code, which includes the following key provisions:

  1. Definition of Cost-Sharing Requirements:

    • Cost-sharing requirements encompass copayments, coinsurance, deductibles, and annual limitations on cost-sharing for covered health care services.

  2. Inclusion of Third-Party Payments:

    • Insurers must include any cost-sharing amounts paid by the enrollee or on behalf of the enrollee by another party when calculating the enrollee's contribution to applicable cost-sharing requirements.

  3. Applicability:

    • The provisions apply to any health benefit plan that is entered into, amended, extended, or renewed on or after January 1, 2026.

  4. Exemption for Prescription Drugs:

    • The bill does not apply to prescription drugs if a medically appropriate generic equivalent is available and has been deemed suitable by the patient's doctor.

  5. Rule-Making Authority:

    • The Idaho Department of Insurance is authorized to create rules to implement the provisions of this section, subject to legislative approval.

Impact

  • Affected Parties:

    • This legislation will primarily affect health insurance companies, insured individuals, and third-party payers. Insured individuals may benefit from reduced out-of-pocket costs due to the inclusion of third-party payments in their cost-sharing calculations.

  • Fiscal Impact:

    • According to the fiscal note, the bill is not expected to result in any increase or decrease in revenue for the State of Idaho or its subdivisions, nor will it incur additional expenditures at the state or local government levels.

Timeline

  • Emergency Clause: The bill includes an emergency declaration, making it effective on July 1, 2025, ensuring that the provisions can be implemented promptly.

Conclusion

House Bill 219 seeks to improve the financial dynamics of health insurance by ensuring that third-party payments are recognized in cost-sharing calculations. This legislation aims to alleviate some of the financial burdens faced by insured individuals, promoting greater equity in health care financing.

Compiled from official sources — confirm details with the bill’s official record.

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