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IA HSB506
SB
Status
Introduced
1/12/2026
Primary Sponsor
Health And Human Services
Click for details
AI Summary
- Health carriers cannot deny coverage for a covered benefit solely because the referral was made by a primary care provider (PCP) who is not in the carrier's network.
- Deductibles, coinsurance, and copayments for services referred by an out-of-network PCP cannot exceed what would apply if the referral came from an in-network provider.
- Carriers may require evidence that the out-of-network PCP 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 the bill include family/general practitioners, pediatricians, internists, obstetricians, gynecologists, advanced registered nurse practitioners, and physician assistants.
- Provisions apply to referrals made on or after July 1, 2026, and the Commissioner of Insurance may adopt rules to administer the section.
Legislative Description
A bill for an act relating to insurance coverage for health care services provided pursuant to a referral by an out-of-network primary care provider.(See HF 2434.)
Last Action
Committee report approving bill, renumbered as HF 2434.
2/12/2026
Committee Referrals
Health and Human Services1/12/2026
Full Bill Text
No bill text available