Bill No. 515 aims to enhance the rights of enrollees in health benefit plans by allowing them to pay out of pocket for health care services and ensuring that these payments are recognized towards their deductibles and out-of-pocket expenses. 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 towards their deductible and out-of-pocket maximum, provided the service is covered under their plan.

Additionally, 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. The legislation also stipulates that the amount counted towards the enrollee's deductible and out-of-pocket maximum cannot exceed the total amount they are contractually obligated to pay during a specified period. This act is set to take effect on November 1, 2025.