WeVote
Log In

Bill

WeVote Research Nonpartisan
Bill Summary · HB 489

Summary — HB 489: Insurance Coverage — Emergency Ambulance Transportation

Status: Passed House; Regular message sent to Senate (transmitted to Senate)
Introduced: 2025 (filed/first read in early 2025) — key provisions effective Oct. 1, 2025 (see “Effective date”)

Main purpose

HB 489 sets a statutory minimum reimbursement framework for emergency ground ambulance services provided by out‑of‑network ambulance service providers and places limits on patient cost‑sharing for those services. The stated goals are to ensure prompt payment to ambulance providers and to protect patients from large surprise bills following emergency transports.

Key provisions

  • Minimum reimbursement to out‑of‑network ambulance providers:
    • If a local government (e.g., by contract or ordinance) has an approved ambulance rate where the transport originated, the insurer must pay 100% of that rate.
    • If no local rate exists, the insurer must pay the lesser of:
    • 400% of the most recent Medicare ambulance rate (CMS) for the same service in the same geographic area, or
    • the provider’s billed charges.
  • Patient cost‑sharing limits:
    • Insurers may collect copays/coinsurance/deductibles but may not impose cost‑sharing higher than the lesser of $100 or 10% of the minimum allowable reimbursement amount under the bill.
  • Payment mechanics and billing:
    • Payment by an insurer in compliance with the minimum reimbursement is considered payment in full (does not preclude collection of permitted patient cost‑sharing).
    • Insurers must remit payments promptly and directly to the ambulance provider (insurers may not send reimbursement checks to the covered person).
  • Definitions and scope:
    • Clarifies definitions for “emergency medical condition,” “emergency medical transportation” (including interfacility ground ambulance and prehospital services), and “out‑of‑network provider.”
  • ERISA plans: The statute does not prevent self‑funded ERISA plans from opting into these provisions.
  • Statutory clean‑up: Certain prior subdivisions of G.S. 58‑3‑190 are repealed as part of the bill’s amendments.

Who is affected

  • Out‑of‑network ambulance service providers (receiving a statutory minimum payment).
  • Health insurers and health benefit plans regulated under state law (financial/administrative obligations).
  • Patients/covered persons (reduced exposure to surprise balance bills and capped cost‑sharing).
  • Local governments that may set/approve ambulance rates (their rates determine the 100% payment benchmark).

Effective date and application

  • Key provision timing: Section establishing the minimum reimbursement is effective Oct. 1, 2025 and applies to insurance contracts issued, renewed, or amended on or after that date and to ambulance services provided on or after that date. Other parts take effect upon enactment as specified.

Procedural status

  • Passed House (multiple readings and committee actions noted); transmitted to the Senate (Regular Message Sent to Senate). Pending Senate consideration as of the latest legislative action.

Potential impacts (practical consequences)

  • Providers: Greater payment certainty and quicker direct payments for emergency transports; potential increase in collections where local rates or the 400% Medicare benchmark exceed prior insurer payments.
  • Insurers: Increased payment obligations for out‑of‑network ambulance services, potential administrative changes to payment flows and claims processing.
  • Patients: Stronger protection from large surprise bills for emergency ambulance transport through capped cost‑sharing and prohibition on insurers routing reimbursement through the patient.

For the full statutory text and legislative history, consult the bill file and G.S. 58‑3‑190 (as amended) in the North Carolina General Assembly records.

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

Sign in to ask a question.