Bill > HF2434

This bill requires health insurance companies, or "health carriers," to cover health care services when a patient is referred by their primary care provider, even if that provider is not part of the insurance company's network of doctors. This means that if a patient's regular doctor, who is trained to be their first point of contact for health needs and provides ongoing care, refers them to a specialist or for a specific service, the insurance plan must cover it. The bill also states that the patient should not have to pay more out-of-pocket, like higher deductibles or copayments, for these services than they would if their primary care provider was in the insurance network. Health carriers can ask for proof that the primary care provider has a "direct primary care agreement" with the patient, which is a contract where the doctor provides services for a set fee over a period. This new rule applies to referrals made on or after July 1, 2026, and does not apply to self-funded health plans covered by the federal Employee Retirement Income Security Act of 1974 (ERISA).

Business and Industry

Health And Human Services (House)

https://www.legis.iowa.gov/legislation/BillBook?ga=91&ba=HF2434