Bills › HF 2434 › What changed

What changed in HF 2434

The bill as introduced, compared with the version both chambers passed (91st General Assembly). 2 adopted amendments account for the changes.

3 passages reworded, 3 added and 3 removed; 14 of 23 unchanged.

~~Removed~~ AddedIntroduced text Text as passed Amendments

Compares wording only. The printed bills also mark changes to existing law with strikes and underlines, which aren’t shown here.

Section 1.

NEW SECTION. 514C.37 Primary care providers —— insurance requirements.

1. As used in this section, unless the context otherwise requires:

~~a. “Covered benefit” means a health care service to which a covered person is entitled under the terms of a health benefit plan.~~

a. “Covered benefits” means the same as defined in section 514J.102.

~~b. “Covered person” means a policyholder, subscriber, enrollee, or other individual participating in a health benefit plan.~~

b. “Covered person” means the same as defined in section 514J.102.

c. “Direct primary care agreement” means an agreement between a primary care provider and a covered person, or the covered person’s representative, in which the primary care provider agrees to provide health care services for a specified period of time to the covered person for a service charge.

d. “Health benefit plan” means a policy, contract, certificate, or agreement offered or issued by a health carrier to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services.

d. “Health benefit plan” means the same as defined in section 514J.102.

e. “Health care professional” means the same as defined in section 514J.102.

6 unchanged passages

f. “Health care services” means the same as defined in section 514J.102.

g. “Health carrier” means the same as defined in section 514J.102.

h. “Primary care provider” means a health care professional trained to serve as the first contact and to provide continuous and comprehensive care to a covered person, and includes but is not limited to any of the following licensed or certified health care professionals who provide primary care:

(1) A physician who is a family or general practitioner, a pediatrician, an internist, an obstetrician, or a gynecologist.

(2) An advanced registered nurse practitioner.

(3) A physician assistant.

a. Notwithstanding the uniformity of treatment requirements of section 514C.6, a health carrier shall not deny coverage for a covered ~~benefit~~ benefits provided to a covered person solely on the basis that the covered person’s referral to receive the covered ~~benefit~~ benefits was made by a primary care provider who does not participate in the health carrier’s provider network.

b. A health carrier shall not impose a deductible, coinsurance, or copayment for a covered ~~benefit~~ benefits for which a covered person was referred by the covered person’s primary care provider in excess of the deductible, coinsurance, or copayment applicable for the covered ~~benefit~~ benefits had the covered person been referred by a health care professional that participates in the health carrier’s provider network.

c. A health carrier may require a primary care provider to provide evidence that the primary care provider has executed a direct primary care agreement with the covered person, which evidence may include a written attestation or a copy of the executed direct primary care agreement.

3. This section applies to a covered ~~benefit~~ benefits for which a covered person’s primary care provider referred the covered person on or after July 1, 2026.

4. The commissioner of insurance may adopt rules pursuant to chapter 17A to administer this section.