Bills › 91st General Assembly
Relating to insurance coverage for health care services provided pursuant to a referral by an out-of-network primary care provider
Sponsored by the House Health and Human Services Committee
Topics:Health care
Same legislation: HSB 506
Progress
- IntroducedJanuary 12, 2026
- SubcommitteeFebruary 5, 2026
- CommitteeFebruary 10, 2026
- Passed HouseFebruary 25, 2026 · 92–0
- Passed SenateApril 6, 2026 · 47–0
- SignedApril 16, 2026
Signed into law What’s a funnel?
What’s in it
This bill relates to insurance coverage for health care services provided pursuant to a referral by an out-of-network primary care provider. Under the bill, a health carrier (carrier) shall not deny coverage for a covered benefit provided to a covered person solely on the basis that the referral to receive the covered benefit was made by the covered person’s primary care provider (PCP) who does not participate in the carrier’s network. A carrier shall not impose a deductible, coinsurance, or copayment for a covered benefit for which a covered person was referred by the covered person’s PCP greater than what would be applicable to the same benefit had the covered person been referred by an in-network health care professional.
Read the full explanation
A carrier may require a PCP to provide evidence that the PCP executed a direct primary care agreement with the covered person, which evidence may include a written attestation or a copy of the executed agreement. “Covered benefit”, “direct primary care agreement”, and “primary care provider” are defined in the bill. The bill applies to covered benefits for which a covered person’s primary care provider referred the covered person on or after July 1, 2026. The commissioner of insurance may adopt rules to administer the bill.
From the explanation printed with the bill as introduced, written by the Legislative Services Agency. Changed since by amendments S-5117, H-8030; see Amendments. Full bill text
Amendments · 3
2 adopted · 0 failed · 1 pending. Newest first.
History
Meetings
- Wednesday, March 18 · 11:00 AMCommerce committee · RM 116Official meeting page
- Monday, March 9 · 12:30 PMCommerce subcommittee · Room G15Official meeting page
- Tuesday, February 10 · 2:30 PMHealth and Human Services committee · RM 103Official meeting page
- Thursday, February 5 · 12:00 PMHealth and Human Services subcommittee · RM 304Official meeting page
- Tuesday, January 13 · 9:00 AMHealth and Human Services committee · RM 103Official meeting page
Votes
Select a floor vote to see how each legislator voted.
Lobbyist declarations
- Iowa Academy of Family PhysiciansFor
- Iowa Independent Physician GroupFor
- Iowa Integrated Health Planning and Advisory CouncilFor
- Iowa Medical SocietyFor
- Cedar Rapids Metro Economic AllianceUndecided
- Federation of Iowa InsurersUndecided
- Iowa Chiropractic Physicians Clinic LLCUndecided
- Iowa Insurance DivisionUndecided
- Iowa Nurse Practitioners SocietyUndecided
- Iowa Primary Care AssociationUndecided
- Iowa Society of AnesthesiologistsUndecided
- National Association of Benefits and Insurance Professionals-Iowa ChapterUndecided
- Wellmark, Inc.Undecided
Grouped by organization. Lobbying overview →