This bill introduces new requirements for health plans under the Managed Care Law, specifically focusing on "Transparency in Coverage." It establishes key definitions such as "billed charge," "negotiated rate," and "historical net price," and 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 consumer access to healthcare costs. The bill also includes provisions for regular updates to this information and specifies the format and method for disclosures, promoting informed decision-making among consumers.

Furthermore, the bill outlines the responsibilities of the insurance department's commissioner to compile and publicly share this pricing information through an online tool. Health plans are required to update their machine-readable files monthly and may delegate reporting responsibilities to third parties while remaining accountable for compliance. The provisions will take effect for plan years starting on or after January 1, 2026, and the implementation of certain sections is contingent upon the finalization of federal guidance under Presidential Executive Order 14221. The bill includes the insertion of new definitions and requirements while deleting any conflicting provisions from existing law to ensure clarity and compliance with the new transparency standards.