Healthcare (Insurance)

Idaho's H 729, the "Idaho Dental Plan Transparency Act," requires dental health insurance plans (excluding Medicaid, CHIP, short-term plans, and direct primary care) to annually report their "dental loss ratio" (DLR) to the Idaho Department of Insurance. The DLR shows what percentage of premium dollars go directly toward patient dental care versus administrative costs, calculated using specific rules that exclude overhead and other expenses. Starting in 2027, plans must submit these reports by July 31, and the Department will publish the data publicly on a searchable website by January 1 each year for consumers to compare. This law aims to increase transparency about how dental plan premiums are used, without changing coverage or costs.

This bill requires health insurers in Idaho to count all copays, deductibles, and coinsurance paid by or on behalf of plan members when calculating their total out-of-pocket costs for covered health services. It applies to all health benefit plans issued or renewed on or after January 1, 2027, directly affecting insurers and enrollees. Key provisions include excluding prescription drugs from the rule if a medically appropriate generic is available and prescribed, and giving Idaho's Department of Insurance authority to create implementing rules. The law takes effect July 1, 2026, with full application starting in 2027.

Idaho's H 648 requires health benefit plans covering FDA-approved anticancer medications to treat oral and injected drugs equally for cost-sharing (like copays and deductibles) starting January 1, 2027. This directly affects health insurance plans sold in Idaho that cover anticancer medications, ensuring patients pay the same out-of-pocket costs regardless of whether their medication is taken orally or administered via injection. The bill does not prevent insurers from using formularies, prior authorization, or other standard coverage controls. It specifically applies to medications approved by the FDA for cancer treatment, with the law taking effect July 1, 2026, for implementation.

This Idaho bill (H 530) requires health insurance plans to cover anticancer medications with equal cost-sharing for oral and injected treatments. Specifically, it mandates that out-of-pocket costs for oral anticancer drugs cannot exceed $250 per 30-day supply, matching the cost limits for injected options. The law clarifies that plans aren’t required to classify anticancer medications as "medical benefits" but prohibits them from increasing costs or reclassifying coverage to avoid compliance. It takes effect July 1, 2026, directly affecting insurers and patients using oral anticancer medications under Idaho health plans.

This Idaho bill (H 529) allows health insurance policyholders to pay cash directly to providers for covered services at a negotiated discounted price, with that payment counting toward their out-of-pocket deductible and annual maximum. It requires health carriers to count such cash payments toward these limits if the patient negotiated a lower price than the insurance plan’s allowed amount and provides required documentation. The law applies to in-network or out-of-network providers but excludes dental/vision plans, Medicaid, Medicare, and certain short-term policies. Providers must accept cash as full payment and cannot bill patients or insurers for the difference. The provisions take effect July 1, 2026.