This bill introduces new requirements for health plans under the Managed Care Law, specifically focusing on "Transparency in Coverage." It mandates that health plans disclose detailed pricing information, including in-network provider rates, out-of-network allowed amounts, and historical net prices for prescription drugs. This information must be made available in three machine-readable files on the health plan's website, ensuring accessibility and regular updates. Key definitions are provided, such as "billed charge," "billing code," and "bundled payment arrangement." The bill also specifies that health plans must omit data related to claims involving fewer than 20 different payments to protect privacy.

Furthermore, the bill outlines the responsibilities of the commissioner of the insurance department to compile and publish this pricing information, facilitating market-wide comparisons. Health plans are required to update their pricing files monthly and may delegate disclosure responsibilities to third parties while remaining accountable for compliance. The provisions will apply to plan years starting on or after January 1, 2026, and include a contingency clause linking the implementation of certain sections to the finalization of federal guidance under Presidential Executive Order 14221. Overall, the bill aims to enhance transparency in healthcare costs, promoting informed decision-making among consumers.