This bill amends Alaska's health insurance laws by introducing a new section, AS 21.36.497, which establishes standards for the settlement of health insurance claims. In the absence of a contract between health care insurers and providers, the director will set regulations for allowable charges for health care services and supplies. These 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 will be the greater of a specified percentage of the federal Medicare fee schedule or the 75th percentile of charges in the state, with the possibility for the director to set higher limits. Additionally, 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 calculations for 2029 and beyond based on more current data. 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