The bill establishes new insurance coverage requirements for health care services provided following a referral from an out-of-network primary care provider. It defines key terms such as "covered benefit," "covered person," and "direct primary care agreement," and clarifies that a health carrier cannot deny coverage for a benefit solely because the referral was made by a non-network primary care provider. Additionally, the bill stipulates that any deductibles, coinsurance, or copayments imposed by the health carrier for such services cannot exceed those that would apply if the referral had come from an in-network provider.

Furthermore, the bill allows health carriers to request evidence of a direct primary care agreement between the primary care provider and the covered person, which may include a written attestation or a copy of the agreement. This new section will apply to referrals made on or after July 1, 2026, and the commissioner of insurance is authorized to adopt rules to administer these provisions.