House File 2434 - Reprinted HOUSE FILE 2434 BY COMMITTEE ON HEALTH AND HUMAN SERVICES (SUCCESSOR TO HSB 506) (As Amended and Passed by the House February 25, 2026 ) A BILL FOR An Act relating to insurance coverage for health care services 1 provided pursuant to a referral by an out-of-network primary 2 care provider. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 4 HF 2434 (2) 91 nls/ko/md

H.F. 2434 Section 1. NEW SECTION . 514C.37 Primary care providers —— 1 insurance requirements. 2 1. As used in this section, unless the context otherwise 3 requires: 4 a. “Covered benefit” means a health care service to which a 5 covered person is entitled under the terms of a health benefit 6 plan. 7 b. “Covered person” means a policyholder, subscriber, 8 enrollee, or other individual participating in a health benefit 9 plan. 10 c. “Direct primary care agreement” means an agreement 11 between a primary care provider and a covered person, or the 12 covered person’s representative, in which the primary care 13 provider agrees to provide health care services for a specified 14 period of time to the covered person for a service charge. 15 d. “Health benefit plan” means a policy, contract, 16 certificate, or agreement offered or issued by a health carrier 17 to provide, deliver, arrange for, pay for, or reimburse any of 18 the costs of health care services.“Health benefit plan” does 19 not include a self-funded health benefit plan that is governed 20 by the federal Employee Retirement Income Security Act of 1974, 21 29 U.S.C. §1001 et seq. 22 e. “Health care professional” means the same as defined in 23 section 514J.102. 24 f. “Health care services” means the same as defined in 25 section 514J.102. 26 g. “Health carrier” means the same as defined in section 27 514J.102. 28 h. “Primary care provider” means a health care professional 29 trained to serve as the first contact and to provide continuous 30 and comprehensive care to a covered person, and includes but 31 is not limited to any of the following licensed or certified 32 health care professionals who provide primary care: 33 (1) A physician who is a family or general practitioner, a 34 pediatrician, an internist, an obstetrician, or a gynecologist. 35 -1- HF 2434 (2) 91 nls/ko/md 1/ 2

H.F. 2434 (2) An advanced registered nurse practitioner. 1 (3) A physician assistant. 2 2. a. Notwithstanding the uniformity of treatment 3 requirements of section 514C.6, a health carrier shall not deny 4 coverage for a covered benefit provided to a covered person 5 solely on the basis that the covered person’s referral to 6 receive the covered benefit was made by a primary care provider 7 who does not participate in the health carrier’s provider 8 network. 9 b. A health carrier shall not impose a deductible, 10 coinsurance, or copayment for a covered benefit for which a 11 covered person was referred by the covered person’s primary 12 care provider in excess of the deductible, coinsurance, or 13 copayment applicable for the covered benefit had the covered 14 person been referred by a health care professional that 15 participates in the health carrier’s provider network. 16 c. A health carrier may require a primary care provider to 17 provide evidence that the primary care provider has executed a 18 direct primary care agreement with the covered person, which 19 evidence may include a written attestation or a copy of the 20 executed direct primary care agreement. 21 3. This section applies to a covered benefit for which a 22 covered person’s primary care provider referred the covered 23 person on or after July 1, 2026. 24 4. The commissioner of insurance may adopt rules pursuant to 25 chapter 17A to administer this section. 26 -2- HF 2434 (2) 91 nls/ko/md 2/ 2