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LEGISLATURE
OF
THE
STATE
OF
IDAHO
Sixty-eighth
Legislature
Second
Regular
Session
-
2026
IN
THE
HOUSE
OF
REPRESENTATIVES
HOUSE
BILL
NO.
713
BY
HEALTH
AND
WELFARE
COMMITTEE
AN
ACT
1
RELATING
TO
HEALTH
INSURANCE;
AMENDING
CHAPTER
3,
TITLE
41,
IDAHO
CODE,
BY
2
THE
ADDITION
OF
A
NEW
SECTION
41
-
352,
IDAHO
CODE,
TO
ESTABLISH
PROVI
-
3
SIONS
REGARDING
COST
-
SHARING
REQUIREMENTS
FOR
HEALTH
BENEFIT
PLANS;
4
AND
DECLARING
AN
EMERGENCY
AND
PROVIDING
AN
EFFECTIVE
DATE.
5
Be
It
Enacted
by
the
Legislature
of
the
State
of
Idaho:
6
SECTION
1.
That
Chapter
3,
Title
41,
Idaho
Code,
be,
and
the
same
is
7
hereby
amended
by
the
addition
thereto
of
a
NEW
SECTION
,
to
be
known
and
des
-
8
ignated
as
Section
41
-
352,
Idaho
Code,
and
to
read
as
follows:
9
41
-
352.
COST
-
SHARING
REQUIREMENTS
FOR
HEALTH
BENEFIT
PLANS.
(1)
As
10
used
in
this
section:
1
1
(a)
"Cost
-
sharing
requirement"
means
any
copayment,
coinsurance,
de
-
12
ductible,
or
annual
limitation
on
cost
-
sharing
required
by
a
health
13
benefit
plan
for
a
specific
health
care
service
covered
by
the
health
14
benefit
plan
and
includes
any
copayment,
coinsurance,
deductible,
15
or
annual
limitation
subject
to
42
U.S.C.
18022(c)
or
42
U.S.C.
16
300gg
-
6(b).
17
(b)
"Health
care
service"
means
an
item
or
service
furnished
to
an
in
-
18
dividual
for
the
purpose
of
preventing,
alleviating,
curing,
or
healing
19
human
illness,
injury,
or
physical
disability,
including
prescription
20
drugs.
21
(2)
When
calculating
an
enrollee's
contribution
to
any
applicable
22
cost
-
sharing
requirement
for
a
health
care
service,
an
insurer
shall
include
23
any
cost
-
sharing
amounts
paid:
24
(a)
By
the
enrollee;
or
25
(b)
On
behalf
of
the
enrollee
by
another
party.
26
(3)
This
section
applies
to
any
health
benefit
plan
entered
into,
27
amended,
extended,
or
renewed
on
or
after
January
1,
2027.
28
(4)
This
section
shall
not
apply
to
a
health
care
service
that
is
a
pre
-
29
scription
drug
if:
30
(a)
There
is
a
medically
appropriate
generic
equivalent;
and
31
(b)
The
patient's
doctor
has
indicated
that
the
medically
appropriate
32
generic
equivalent
is
appropriate
for
the
patient.
33
(5)
The
department
of
insurance
may
promulgate
rules,
subject
to
leg
-
34
islative
approval,
to
carry
out
the
provisions
of
this
section.
35
SECTION
2.
An
emergency
existing
therefor,
which
emergency
is
hereby
36
declared
to
exist,
this
act
shall
be
in
full
force
and
effect
on
and
after
37
July
1,
2026.
38