The bill, H.B. No. 3414, amends the Insurance Code to establish that insurers providing coverage for primary care services must recognize direct fees charged by physicians offering direct primary care as fees for medically necessary covered medical or health care services. This new provision, added as Subsection (a-1) to Section 1301.140, clarifies the definitions of "direct fee" and "direct primary care" as per Section 162.251 of the Occupations Code.

The changes will apply specifically 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 to adjust to the new requirements regarding out-of-pocket expense credits for payments made directly to physicians in the context of direct primary care.

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