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HB 456

No Surprises for Ambulance Services Act.

2025-2026 Session Introduced by Eric Ager and 16 co-sponsors

The bill reduces surprise ambulance costs by requiring parity with in-network emergency coverage and capping out-of-network costs for nonemergency ground ambulance transport.

Passed 1st Reading
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Bill Summary · HB 456

HB 456 — “No Surprises for Ambulance Services Act” — Summary

Status: Introduced (passed 1st reading)
Primary sponsor: Rep. von Haefen (with multiple co-sponsors)
Primary subject areas: ambulance services, health insurance, State Health Plan, appropriations

Purpose

To reduce “surprise” cost‑sharing for patients who use ground ambulance services (both emergency and non‑emergency) by (1) clarifying insurer obligations for emergency ambulance coverage and parity of cost‑sharing, and (2) limiting patient out‑of‑network cost‑sharing for nonemergency ground ambulance transport. The bill also adds the new coverage requirement to the State Health Plan and funds the Plan to cover the change.

Key provisions

  • Amends G.S. 58‑3‑190 (coverage required for emergency care):

    • Reaffirms that insurers must cover emergency services (including prehospital care and ambulance transportation) when a prudent layperson would reasonably believe an emergency existed and without prior authorization.
    • Requires payment decisions be based on the presenting history/symptoms (retrospective review).
    • Prohibits insurers from imposing different cost‑sharing for emergency services (including emergency ambulance transport) than would apply if the provider were in‑network (i.e., cost‑sharing parity).

  • Adds G.S. 58‑3‑193 — Coverage for nonemergency ground ambulance transportation:

    • Allows usual cost‑sharing (deductible, coinsurance, copay) for nonemergency ambulance service.
    • Caps patient cost‑sharing for nonemergency ground ambulance transported by an out‑of‑network provider at no more than 110% of the cost‑sharing amount that would apply for the same nonemergency service delivered by an in‑network provider.

  • State Health Plan (G.S. 135‑48.51):

    • Requires the State Health Plan to comply with the new nonemergency ambulance coverage rule (i.e., adds G.S. 58‑3‑193 to the Plan’s mandated provisions).

  • Appropriation:

    • Appropriates $1,000,000 recurring (General Fund) to the Department of State Treasurer, effective July 1, 2025, to support the additional coverage required by the Act.

Who is affected

  • Insurers and health benefit plans selling coverage in the State (obligations re: emergency coverage, disclosures, cost‑sharing parity).
  • Enrollees/insured patients (reduced risk of surprise bills for ambulance transport; defined caps for out‑of‑network nonemergency transports).
  • Ground ambulance providers — in‑network and out‑of‑network — (reimbursement dynamics, potential negotiation/contract impacts).
  • State Health Plan and Department of State Treasurer (implementation and budget impacts).

Fiscal and timeline highlights

  • Intended effective dates:
    • Provisions governing insurance contracts: apply to contracts issued, renewed, or amended on or after October 1, 2025.
    • Appropriation to State Health Plan: funds effective July 1, 2025.
  • Budgetary impact: direct recurring appropriation for the State Health Plan ($1M/year for the 2025–27 biennium); insurers and plans may experience administrative and actuarial effects (potential premium or reimbursement adjustments) from constrained patient cost‑sharing and parity requirements.

Policy implications / likely impacts

  • Reduces consumer exposure to surprise out‑of‑network ambulance charges and improves transparency of cost‑sharing.
  • May shift a portion of nonemergency out‑of‑network cost burdens onto insurers or plans (or influence network contracting and reimbursement negotiations with ambulance providers).
  • Requires plan and insurer consumer disclosures about emergency coverage and cost‑sharing.

Procedural notes

  • Introduced and referred to relevant committees (health/insurance and appropriations). Key statutory changes: amends G.S. 58‑3‑190 and G.S. 135‑48.51; adds G.S. 58‑3‑193.
  • Check the legislature’s official status page for the bill’s current committee actions, amendments, and final disposition.

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

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