IA HF2434

Health carriers cannot deny coverage for a covered benefit solely because the referral came from a primary care provider who is not in the carrier's network.

Cost-sharing (deductibles, coinsurance, copayments) for services referred by an out-of-network primary care provider cannot exceed what would apply if an in-network provider made the referral.

Health carriers may require evidence that the out-of-network primary care provider has a direct primary care agreement with the covered person, such as a written attestation or copy of the agreement.

Primary care providers covered under this bill include physicians (family practitioners, pediatricians, internists, OB/GYNs), advanced registered nurse practitioners, and physician assistants.

Applies to referrals made on or after July 1, 2026, and does not cover self-funded plans governed by federal ERISA law.