health insurers; savings incentive program

Plain English Breakdown

The bill changed language from 'may establish' to 'shall establish', making the program mandatory, but the effective date is not yet set.

SB1159: Health Insurer Savings Incentive Program

This law requires Arizona health insurers to create programs that reward patients who pay less than usual for medical services by applying savings toward their deductibles or giving them cash.

What This Bill Does

• Requires health insurers to establish a program offering incentives when enrollees receive care at prices below the insurer's usual reimbursement rate.
• Allows eligible enrollees to apply the amount they paid for lower-cost services toward their deductible and out-of-pocket maximums.
• Mandates that insurers reimburse 50% of the difference between what the enrollee paid and the insurer's usual reimbursement amount.
• Permits insurers to pay this reimbursement by depositing funds into a health savings account, a 530A account, or providing cash.

Who It Names or Affects

• Health insurers operating in Arizona
• Enrollees who receive covered medical services from providers charging below the usual rate

Terms To Know

Usual reimbursement

The amount a health insurer normally pays an in-network provider or facility for a specific service.

530A account

A type of savings account defined by federal law (26 U.S. Code section 530A) that can receive reimbursements from insurers under this program.

Limits and Unknowns

• The effective date of the law is not listed in the provided text.
• The bill does not specify which medical services qualify for the incentive beyond being 'medically necessary' and 'covered'.
• The rules do not state how insurers must calculate or verify that a price is below their usual reimbursement.

Official Summary Text

SB1159 - health insurers; savings incentive program

Current Bill Text

SB1159 - 572R - I Ver

REFERENCE TITLE:
health insurers; savings incentive program

State of Arizona

Senate

Fifty-seventh Legislature

Second Regular Session

2026

SB 1159

Introduced by

Senator
Shamp

AN
ACT

amending section 20-111, arizona
revised statutes; RELATING to health insurers.

(TEXT OF BILL BEGINS ON NEXT PAGE)

Be it enacted by the Legislature of the State of Arizona:

Section 1. Section 20-111, Arizona Revised
Statutes, is amended to read:

START_STATUTE
20-111.

Health insurers; savings incentive programs; definitions

A. A health insurer
may

shall
establish a program that provides a savings incentive for
enrollees for medically necessary covered health care services that health care
providers and health care facilities provide at a price that is

below the health insurer's usual reimbursement.

B. The program may enable

an
eligible enrollee who receives covered health care services from a health care
provider or health care facility at a price below the health insurer's usual
reimbursement to have the amount the enrollee pays applied toward the
enrollee's deductible and out-of-pocket maximum and be reimbursed
for
a portion

fifty percent
of the amount of the difference between the price
the enrollee paid

and the health insurer's
usual reimbursement.
� A health insurer may reimburse an eligible
enrollee by doing either of the following:

1. Making a deposit into either:

(
a
) A health
savings account.

(
b
) A 530A
account as prescribed in 26 United States Code section 530A.

2. Providing the amount in cash.

C. For the purposes of this section:

1. "Health care facility" means a
hospital, outpatient surgical center, health care laboratory, diagnostic
imaging center or urgent care center.

2. "Health care provider" has the same
meaning prescribed in section 32-3216.

3. "Health insurer" has the same meaning prescribed
in section 32-3216.

4. "Usual reimbursement" means the amount
the health insurer would ordinarily pay an in-network health care provider or
an in-network health care facility for the service.
END_STATUTE