Bill Analyses and Ratings
Bill Information: H0713 – Health Insurance Cost-Sharing Calculation Mandate
Bill Summary
House Bill 713 creates new Section 41-352 in Idaho Code, establishing requirements for how health insurers calculate enrollees’ contributions toward deductibles, copayments, coinsurance, and annual out-of-pocket limits. The bill mandates that insurers must count not only payments made directly by enrollees, but also any cost-sharing amounts paid on behalf of enrollees by third parties—such as pharmaceutical manufacturer copay assistance programs, charitable foundations, or other entities.
The legislation applies to all health benefit plans entered into, amended, extended, or renewed on or after January 1, 2027. It includes an exception for prescription drugs when a medically appropriate generic equivalent exists and the patient’s doctor has indicated the generic is appropriate for the patient. The Department of Insurance receives authority to promulgate rules to implement these provisions, subject to legislative approval.
The bill includes an emergency clause declaring it effective July 1, 2026, six months before the requirements apply to health plans. This advance notice period allows insurers time to modify their systems and processes to comply with the new cost-sharing calculation requirements.
Overall Assessment
This bill imposes new regulatory requirements on health insurers by mandating they count third-party payments toward enrollees’ out-of-pocket maximums and deductibles. The legislation expands government oversight of private health insurance contracts, requiring insurers to modify their cost-sharing calculation systems and potentially affecting how pharmaceutical copay assistance programs function. While the bill may reduce out-of-pocket costs for some patients receiving third-party assistance, it adds compliance burdens on insurers and increases state regulation of the private healthcare market.
Rating Breakdown
ARTICLE I. RESPONSIBILITY IN GOVERNMENT (-1)
Section 41-352(2) creates a new regulatory mandate requiring insurers to include third-party payments in cost-sharing calculations, expanding government oversight of private health insurance contracts. Section 41-352(5) grants the Department of Insurance additional rulemaking authority to implement these requirements. This expansion of government regulation conflicts with principles favoring minimal government intervention in private enterprise and healthcare delivery systems.
ARTICLE II. CITIZEN INVOLVEMENT IN GOVERNMENT (0)
This bill regulates health insurance cost-sharing calculations and does not address citizen participation in government, voting procedures, elections, or political processes.
ARTICLE III. EDUCATION (0)
This bill concerns health insurance regulations and has no connection to education policy, school choice, curriculum, or parental rights in education.
ARTICLE IV. AGRICULTURE (0)
This bill addresses health insurance requirements and does not involve agricultural policy, farming, ranching, or agricultural markets.
ARTICLE V. WATER (0)
This bill regulates health benefit plans and has no connection to water rights, water management, or water policy.
ARTICLE VI. NATURAL RESOURCES AND ENVIRONMENT (0)
This bill concerns health insurance cost-sharing and does not address environmental stewardship, natural resources, or land management.
ARTICLE VII. ENERGY (0)
This bill regulates health insurance and has no connection to energy policy, energy independence, or energy resources.
ARTICLE VIII. IDAHO NATIONAL LABORATORIES (0)
This bill addresses health insurance requirements and does not involve the Idaho National Laboratory, nuclear research, or energy technology.
ARTICLE IX. PRIVATE PROPERTY RIGHTS (0)
This bill regulates health insurance contracts and does not address property rights, eminent domain, or Fifth Amendment takings protections.
ARTICLE X. STATE AND FEDERAL LANDS (0)
This bill concerns health insurance regulations and has no connection to federal or state land management, land transfers, or public lands policy.
ARTICLE XI. WILDLIFE MANAGEMENT (0)
This bill addresses health insurance cost-sharing and does not involve fish and wildlife management, hunting, fishing, or predator control.
ARTICLE XII. ECONOMY (0)
While Section 41-352(2) imposes new compliance requirements on health insurers, the bill does not specifically target small businesses or address the broader economic concerns emphasized in this metric. The regulatory burden falls on large insurance companies rather than the small business sector.
ARTICLE XIII. HEALTH AND WELFARE (0)
Section 41-352(2) adds new government regulation to health insurance by mandating specific cost-sharing calculation methods, which conflicts with support for minimal government regulation in healthcare delivery. However, the bill operates within the existing private insurance framework and may reduce patient costs, creating competing considerations that balance to a neutral impact.
ARTICLE XIV. AMERICAN FAMILY (0)
This bill regulates health insurance cost-sharing calculations and does not address family values, parental rights, marriage, or social issues related to the family structure.
ARTICLE XV. OLDER AMERICANS (0)
While older Americans use health insurance, this bill applies generally to all enrollees and does not specifically address policies affecting older Americans, retirement security, or age-related healthcare concerns.
ARTICLE XVI. LAW AND ORDER WITH JUSTICE (0)
This bill concerns health insurance regulations and has no connection to criminal justice, law enforcement, gun rights, or judicial processes.
ARTICLE XVII. NATIONAL DEFENSE – SECURING THE BORDER (0)
This bill addresses health insurance requirements and does not involve military affairs, veterans' issues, national defense, border security, or terrorism.
ARTICLE XVIII. ELECTION OF JUDGES AND IDAHO SUPREME COURT JUSTICES (0)
This bill regulates health insurance and has no connection to judicial elections, court procedures, or constitutional interpretation.
ARTICLE XIX. RELIGIOUS LIBERTY (0)
This bill concerns health insurance cost-sharing calculations and does not address religious freedom, conscience clauses, or the free exercise of religion.