HB 2486 Summary

• Requires health insurers offering plans in Arizona to establish a comparable health care service incentive program with an interactive website tool or toll-free number allowing enrollees to compare allowed amounts and quality data among network providers and obtain out-of-pocket cost estimates for nonemergency procedures, effective January 1, 2023.

• Mandates health insurers in the individual and small group market to establish shared savings programs that directly incentivize enrollees to use lower-cost in-network providers through cash payments, gift cards, premium reductions, or other approved methods.

• Allows enrollees to obtain covered health care services from out-of-network U.S. providers at costs equal to or less than the in-network average and have those payments applied toward their deductible and out-of-pocket maximum if proof of payment is submitted.

• Prohibits health insurers from denying payment for in-network covered services solely because the referral was made by a non-network provider.

• Requires the department director to conduct annual studies beginning March 1, 2023 and submit aggregate reports to legislative committees on program enrollment, incentive usage, and cumulative program effects by April 15 of each year.