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. (Formerly HSB 506 .) Effective date: 07/01/2026.

STATE OF IOWA
KIM REYNOLDS
GOVERNOR
April 16,2026
The Honorable Paul Pate
Secretary of State of Iowa
State Capitol
Des Moines, Iowa 50319
Dear Mr. Secretary,
I hereby transmit:
House File 2434, an Act relating to insurance coverage for health care services provided
pursuant to a referral by an out-of-network primary care provider.
The above House File is hereby approved on this date.
Sincerely,
Kim w^nolds
Governor of Iowa
cc: Secretary of the Senate
Clerk of the House
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House File 2434
AN ACT
RELATING TO INSURANCE COVERAGE FOR HEALTH CARE SERVICES
PROVIDED PURSUANT TO A REFERRAL BY AN OUT-OF-NETWORK PRIMARY
CARE PROVIDER.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
Section 1. NEW SECTION . 514C.37 Primary care providers —
insurance requirements.
1. As used in this section, unless the context otherwise
requires :
a. "Covered benefits" means the same as defined in section
514J.102.
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.
House File 2434, p. 2
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.
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.
2. a. Notwithstanding the uniformity of treatment
requirements of section 514C.6, a health carrier shall not
deny coverage for covered benefits provided to a covered
person solely on the basis that the covered person's referral
to receive the covered 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 covered 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 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 covered benefits for which a
covered person's primary care provider referred the covered
person on or after July 1, 2026.
House File 2434, p. 3
4. The commissioner of insurance may adopt rules pursuant to
chapter 17A to administer this section.
PÄT GRASSLE AMY SINC
Speaker ofr the House President of the Senate
I hereby certify that this bill originated in the House and
is known as House File 2434, Ninety-first General Assembly.
WA n _ MEGHAN NELSON
Chief Clark of ±-hp House
Approved 2026
’ KIM REYlfclÄS C 1
Governor