HF2434: Out-of-Network Referral Coverage

Prohibits health insurance carriers from denying coverage for health care services or imposing higher out-of-pocket costs solely because a referral was made by an out-of-network primary care provider. The carrier may require evidence of a direct primary care agreement. Effective for referrals made on or after 7/1/2026.

Key Points & Impacts

• Prohibits denial of coverage for services referred by out-of-network primary care providers solely due to network status.

• Prevents health carriers from imposing higher deductibles, coinsurance, or copayments for such referrals than would apply to in-network referrals.

• Allows health carriers to require evidence of a direct primary care agreement between the provider and the covered person, such as a written attestation or agreement copy.

• Applies to referrals made by primary care providers on or after July 1, 2026.

• Authorizes the commissioner of insurance to adopt rules to administer these provisions.