Includes whereas clauses.

Part I.

Enacts GS 58-3-182 to cap cost-sharing for any health benefit plan (plan) for prescription drug coverage at $2,000 annually per covered person. Specifies that cost-sharing includes copayments, deductibles, and other out-of-pocket expenses for a prescription drug. Applies to insurance contracts entered into, renewed, or amened on or after October 1, 2026.

Part II.

Amends new GS 58-3-182, adding a provision to require nonemergency care provided at an in-network facility of a covered individual's health benefit plan to be charged to the individual at an in-network rate. Bars plans from allowing cost-sharing at an out-of-network rate if the facility is in the plan's network.

Amends GS 58-3-200 regarding the use of penalties for services outside of a health benefit plan's provide network when a contracted provider is reasonably available to the insured without unreasonable delay. Provides that upon notice or request from the insured, an insurer must determine whether a contracted provider is available to the insured without unreasonable delay by referencing the insured's location and specific medical needs.

Applies to healthcare services provided on or after October 1, 2026, and contracts issued, renewed, or amended on or after that date.

Requires that emergency ground ambulance services by considered part of the essential health benefit package under the specified federal law beginning with the 2027 calendar year. Directs the Commissioner of Insurance to share this change with the Centers for Medicare and Medicaid Services and insurers offering plans in the State on the federally facilitated marketplace.

Part III.

Enacts new Article 11C to GS Chapter 131E, Fair Billing and Collection Practices for Hospitals and Ambulatory Surgical Facilities. Recodifies GS 131E-91 (concerning fair billing and collections) as GS 131E-214.50 and amends the statute as follows. Adds to the collections practices hospitals and ambulatory surgical facilities must adhere to (1) bars referring a patient's unpaid bill to a collections entity unless an informed decision is made that the patient is not eligible for financial assistance under the hospital or facility's policies, and (2) bars reporting a patient's unpaid bill to a credit reporting agency until the bill is at least 180 days past due. 

Part IV. 

Amends GS 131E-214.13 governing pricing disclosure for frequently reported Diagnostic Related Group (DRG), Current Procedural Technology (CPT), and the Healthcare Common Procedure Coding System (HCPCS). Adds CPT, DRG, HCPCS, and statewide data processor to the defined terms. Changes the reporting requirements in subsections (b) and (d) to now require hospitals to quarterly (was, annually) report to the statewide data processor (was, the Department of Health and Human Services (DHHS)) specified information about (1) the 100 most frequently reported admissions by DRG for inpatients and (2) total costs for the 20 most common surgical procedures and the 20 most common imaging procedures performed in outpatient settings or ambulatory surgical facilities (facilities) along with CPT and HCPCS codes. Specifies that when calculating the amount, each hospital or facility must include charges for each billable item and service associated with the DRG or procedure regardless of whether a physician or nonphysician practitioner performed the service. Reorganizes the rulemaking provisions and adds that the Medicare Care Commission (Commission) must establish procedures for the statewide data processor to receive receive and submit data reported to DHHS for publication on its website. Makes conforming changes.

Enacts GS 131E-214.18 to authorize DHHS to assess civil penalties for violations of Article 11B in addition to any federal penalty. Sets the daily penalty at no less than .01% of the annual salary of the CEO of the noncompliant hospital or facility or more than $2,000.

Adds receipt of data from hospitals and facilities reported pursuant to GS 131E-214.13, as amended, to the duties of a statewide data processor set forth in GS 131E-214.4 and requires submitting the data to DHHS.

Makes the above changes effective on the later of January 1, 2027, or the date rules adopted by the Commission regarding uniform reporting pursuant to GS 131E-214.13(d) becomes effective. Directs the Commission to notify the Revisor of Statutes when rules pursuant to GS 131E-214.13(f1)(1) and (2) become effective. 

Enacts GS 131E-214.52 to require facilities to provide a written, itemized list of expected charges within three business days of the expected service when a patient requests a good-faith estimate. Requires the estimate be comprehensible to laypersons and include DRG, CPT, or HCPCS code for each expected charge. Prohibits the patient's final bill from exceeding more than 5% of any good-faith estimate provided under the statute. Directs DHHS to adopt implementing rules. Includes defined terms. Effective on the later of January 1, 2027, or the date the implementing rules take effect. Directs DHHS to notify the Revisor when the rules become effective.

Part V.

Appropriates $2.5 million in recurring funds beginning in 2026-27 from the General Fund to the Department of Insurance to implement and enforce Parts I and II of the act. Appropriates $2.5 million in recurring funds beginning in 2026-27 from the General Fund to DHHS to implement and enforce Parts III and IV of the act. Effective July 1, 2026.