This bill amends Alaska's health insurance laws by introducing new standards for the settlement of health insurance claims, specifically regarding allowable charges for health care services and supplies. A new section, AS 21.36.497, mandates that in the absence of a contract between health care insurers and providers, the director will establish regulations for setting these allowable charges. The charges must be based on the most current data reflecting amounts charged by providers over a 12-month period, ensuring uniformity across the state. The allowable charge must not be less than the 75th percentile of charges for the service or supply, with the possibility for the director to set a higher percentile. Additionally, health care insurers are required to periodically audit their methodologies and update allowable charges at least every five years.

The bill also includes a transition provision that allows health care insurers to set allowable charges for the calendar year 2026 based on data from 2023 or earlier, with subsequent years requiring the use of the most current data available at that time. The effective date for this legislation is set for January 1, 2026.

Statutes affected:
SB0121A, AM SB 121, introduced 03/05/2025: 21.54.500
SB0121B, AM CSSB 121(HSS), introduced 03/31/2025: 21.54.500