The bill, H.B. No. 3414, amends the Insurance Code to establish provisions regarding out-of-pocket expense credits for payments made by insured individuals directly to physicians providing direct primary care. Specifically, it adds a new subsection (a-1) to Section 1301.140, which mandates that insurers offering coverage for primary care services must consider direct fees charged by physicians for direct primary care as fees for medically necessary covered medical or health care services. The bill also defines "direct fee" and "direct primary care" in accordance with existing definitions in the Occupations Code.

This new provision will apply exclusively to preferred provider benefit plans that are delivered, issued for delivery, or renewed on or after January 1, 2026. The bill is set to take effect on September 1, 2025, allowing time for insurers and healthcare providers to adjust to the new requirements.

Statutes affected:
Introduced: Insurance Code 1301.140 (Insurance Code 1301)