This bill introduces new requirements for health plans aimed at enhancing transparency in healthcare pricing under a new subdivision of the Managed Care Law titled "Transparency in Coverage." It defines key terms such as "billed charge," "negotiated rate," and "historical net price," and mandates that health plans disclose specific 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 clear cost information. The bill also requires health plans to update this information regularly and outlines the necessary details to be included in the files, such as billing codes and provider identifiers.

Furthermore, the bill stipulates that health plans must report pricing data in a standardized format that aligns with federal guidelines, making it easily comparable across different plans and providers. It mandates that this pricing information be publicly accessible without conditions, such as user accounts. The commissioner of the insurance department is tasked with compiling and making this information available through an online tool. Health plans are required to update their files monthly and can delegate reporting responsibilities to third-party administrators. The provisions will apply to plan years starting on or after January 1, 2026, and include protections against penalties for good faith errors in reporting. The act will take effect six months after federal guidance under Executive Order 14221 is finalized.