00                      CS FOR SENATE BILL NO. 4(L&C)                                                                     
01 "An Act relating to a health care insurance policy incentive program; relating to health                                
02 care services; and providing for an effective date."                                                                    
03 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA:                                                                
04    * Section 1. The uncodified law of the State of Alaska is amended by adding a new section                          
05 to read:                                                                                                                
06       SHORT TITLE. This Act may be known as the Alaska Health Care Consumer's Right                                     
07 to Shop Act.                                                                                                            
08    * Sec. 2. AS 21.36.100 is amended to read:                                                                         
09            Sec. 21.36.100. Rebates. Except as provided in AS 21.96.220 or otherwise                               
10 expressly provided by law, a person may not knowingly permit or offer to make or                                        
11 make a contract of life insurance, life annuity or health insurance, or agreement under                                 
12 the contract other than as plainly expressed in the contract, or pay, allow, give or offer                              
13 to pay, allow, or give, directly or indirectly, as inducement to the insurance, or                                      
14 annuity, a rebate of premiums payable on the contract, or a special favor or advantage                                  

01 in the dividends or other benefits, or paid employment or contract for services of any                                  
02 kind, or any valuable consideration or inducement whatever not specified in the                                         
03 contract; or directly or indirectly give, sell, purchase or offer to agree to give, sell,                               
04 purchase, or allow as inducement to the insurance or annuity or in connection                                           
05 therewith, whether or not to be specified in the policy or contract, an agreement of any                                
06 form or nature promising returns, profits, stocks, bonds, or other securities, or interest                              
07 present or contingent in the contract or as measured by the contract, of an insurance                                   
08 company or other corporation, association, or partnership, or dividends or profits                                      
09 accrued or to accrue under the contract; or offer, promise, or give anything of value                                   
10       that is not specified in the contract.                                                                            
11    * Sec. 3. AS 21.96 is amended by adding new sections to read:                                                      
12             Article 2. Health Care Insurance Policy Incentive Program.                                                
13 Sec. 21.96.210. Access to payment information. A health care insurer that                                             
14 offers a health care insurance policy in the group or individual market shall provide                                   
15 comprehensive comparison guidance by telephone and make available on the Internet                                       
16 website of the insurer a price comparison tool that, to the extent practicable, allows an                               
17 individual enrolled in or covered under a health care insurance policy to compare the                                   
18 amount of cost sharing that the individual would be responsible for paying under the                                    
19 policy for a specific item or service provided in the same policy year and geographic                                   
20 region by each provider participating in the policy. At a minimum, the health care                                      
21       insurer shall comply with 42 U.S.C. 300gg-114.                                                                    
22 Sec. 21.96.220. Incentive program. (a) A health care insurer that offers a                                            
23 health care insurance policy in the group or individual market shall develop and                                        
24 implement a program that provides a monetary incentive for a covered person enrolled                                    
25 in a health care insurance policy to elect to receive a covered health care service under                               
26 the health care insurance policy from a health care provider that charges less than the                                 
27 median contracted rate recognized by the health care insurer for that health care                                       
28       service.                                                                                                          
29 (b)  A health care insurer that offers a health care insurance policy in the group                                      
30 or individual market shall provide an incentive payment to a covered person as                                          
31 provided in this subsection. An incentive may be calculated as a percentage of the                                      

01 difference in price as a flat dollar amount or by another reasonable methodology                                        
02 adopted by the director by regulation. A health care insurer is not required to provide                                 
03 an incentive payment to a covered person if the cost saved by the health care insurer is                                
04       $200 or less.                                                                                                     
05 (c)  If a covered person receives coverage under a group health care insurance                                          
06 policy offered by an employer, a health care insurer shall provide the covered person                                   
07 with an incentive of at least 33.4 percent of the costs saved by the health care insurer                                
08 resulting from the covered person's election to receive a health care service from a                                    
09 health care provider that charges less than the median of the contracted rates                                          
10 recognized by the health care insurer for that health care service. The health care                                     
11 insurer shall provide the employer with at least 33.3 percent of the costs saved by the                                 
12       health care insurer resulting from the covered person's election.                                                 
13 (d)  If a covered person receives coverage under a health care insurance policy                                         
14 offered in the individual market, a health care insurer shall provide the covered person                                
15 with an incentive of at least 50 percent of the costs saved by the health care insurer                                  
16       resulting from the covered person's election.                                                                     
17            (e)  An incentive payment to a covered person under this section is not                                      
18                 (1)  a violation of AS 21.36.100; or                                                                    
19 (2)  an administrative expense of the health care insurer for rate                                                      
20       development or rate filing purposes.                                                                              
21 Sec. 21.96.230. Program availability. A health care insurer that offers a                                             
22 health care insurance policy in the group or individual market shall make an incentive                                  
23 program under AS 21.96.220 available as a component of a health care insurance                                          
24 policy offered in this state. Annually, at enrollment or renewal, a health care insurer                                 
25 shall provide notice about the availability of the program to a person covered under a                                  
26       health care insurance policy eligible for the program.                                                            
27 Sec. 21.96.240. Filing requirements. Before offering an incentive program                                             
28 under AS 21.96.220, a health care insurer that offers a health care insurance policy in                                 
29 the group or individual market shall file a description of the program with the director                                
30 in the manner determined by the director. The director may review the filing to                                         
31 determine whether the incentive program complies with the requirements of                                               

01       AS 21.96.210 - 21.96.300.                                                                                         
02 Sec. 21.96.250. Out-of-network health care providers. If a covered person                                             
03 participates in an incentive program under AS 21.96.220 and elects to receive a health                                  
04 care service under AS 21.96.220(a) from an out-of-network health care provider that                                     
05 results in a savings for the health care insurer, the health care insurer shall apply the                               
06 amount paid for the health care service toward the cost sharing owed by the covered                                     
07 person as specified in the applicable health care insurance policy as if the health care                                
08       services were provided by an in-network health care provider.                                                     
09 Sec. 21.96.260. Reporting requirements. A health care insurer shall, at the                                           
10 request of the director, annually provide information to the director relating to an                                    
11       incentive program under AS 21.96.220 for the most recent calendar year that includes                              
12                 (1)  the total number of incentive payments;                                                            
13 (2)  information on the use of the incentive program by category of                                                     
14       service;                                                                                                          
15                 (3)  the total amount of incentive payments;                                                            
16 (4)  the average amount of each incentive payment for each category of                                                  
17       service;                                                                                                          
18 (5)  the total savings achieved below the average price of the health                                                   
19       care service in each category of service; and                                                                     
20 (6)  the total number and percentage of covered persons who                                                             
21       participated in the incentive program.                                                                            
22 Sec. 21.96.270. Applicability. (a) Except as provided in (b) of this section,                                         
23 AS 21.96.210 - 21.96.300 apply to a health care insurance policy or contract but do                                     
24       not apply to excepted benefits.                                                                                   
25 (b)  AS 21.96.210 - 21.96.300 apply to excepted benefits provided under a                                               
26       dental insurance policy or a vision insurance policy.                                                             
27            (c)  In this section, "excepted benefits" has the meaning given in AS 21.54.160.                             
28            Sec. 21.96.300. Definitions. In AS 21.96.210 - 21.96.300,                                                  
29                 (1)  "health care insurance" has the meaning given in AS 21.12.050;                                     
30                 (2)  "health care insurer" has the meaning given in AS 21.54.500;                                       
31                 (3)  "health care provider" has the meaning given in AS 18.23.400(n);                                   

01                 (4)  "health care service" has the meaning given in AS 18.23.400(n);                                    
02                 (5)  "policy" has the meaning given in AS 21.97.900.                                                    
03    * Sec. 4. The uncodified law of the State of Alaska is amended by adding a new section to                          
04 read:                                                                                                                   
05 TRANSITION: REGULATIONS. The director of the division of insurance may adopt                                            
06 regulations necessary to implement this Act. The regulations take effect under AS 44.62                                 
07 (Administrative Procedure Act), but not before the effective date of the law implemented by                             
08 the regulation.                                                                                                         
09    * Sec. 5. Section 4 of this Act takes effect immediately under AS 01.10.070(c).                                    
10    * Sec. 6. Except as provided in sec. 5 of this Act, this Act takes effect January 1, 2026.