This bill establishes new insurance coverage requirements for health care services provided following a referral from an out-of-network primary care provider (PCP). It mandates that health carriers cannot deny coverage for a covered benefit solely based on the PCP's out-of-network status. Additionally, health carriers are prohibited from imposing higher deductibles, coinsurance, or copayments for services referred by an out-of-network PCP compared to those referred by an in-network provider. The bill also allows carriers to request evidence of a direct primary care agreement between the PCP and the covered person.

The provisions of this bill will apply to covered benefits for referrals made on or after July 1, 2026. The bill defines key terms such as "covered benefit," "direct primary care agreement," and "primary care provider," and grants the commissioner of insurance the authority to adopt rules for its administration.