Bill > HB3414

This bill modifies Texas insurance law to require insurers who provide coverage for primary care services to treat direct fees charged by physicians providing direct primary care as medically necessary covered medical services. "Direct primary care" is a healthcare model where patients pay physicians a recurring fee (usually monthly) for a defined set of primary care services outside of traditional insurance billing. The bill specifically requires insurers to recognize these direct fees when calculating out-of-pocket expenses for preferred provider benefit plans. The new provisions will apply to insurance plans delivered, issued, or renewed on or after January 1, 2026, and the bill itself will take effect on September 1, 2025. By mandating that direct primary care fees be considered equivalent to traditional medical service fees, the bill aims to provide more flexibility and potentially lower costs for patients who choose direct primary care arrangements.

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https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=HB3414