Senate Bill No. 515 aims to enhance the payment process for health care services by allowing enrollees to pay out of pocket for services and ensuring that these payments are recognized by their health benefit plans. The bill defines key terms such as "health benefit plan," "health care provider," and "health care service," while also outlining the conditions under which enrollees can submit documentation to their carriers. Specifically, if an enrollee negotiates a lower price for a medically necessary service and pays out of pocket, they can send documentation to their carrier to have the amount counted toward their deductible and out-of-pocket expenses.

The bill mandates that health care providers must accept the negotiated payment as full payment and prohibits them from billing the enrollee or the health benefit plan for any remaining balance. Additionally, it stipulates that the amount counted toward the enrollee's deductible and out-of-pocket maximum cannot exceed the total out-of-pocket cost required during a contractually agreed period. This legislation is set to take effect on November 1, 2025.