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HB 3414

Relating to preferred provider benefit plan out-of-pocket expense credits for payments made by an insured directly to a physician providing direct primary care.

89th Legislature (2025) Introduced by Tom Oliverson

HB 3414 allows direct payments to primary care physicians to count toward insurance plan deductibles and cost-sharing, enabling integration of direct primary care with traditional coverage.

Referred to Insurance
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Bill Summary · HB 3414

Legislative bill overview

HB 3414 establishes a credit mechanism for out-of-pocket expenses in preferred provider benefit plans when insureds pay directly to physicians providing direct primary care services. The bill allows these direct payments to count toward the plan's deductible, copayment, or coinsurance requirements, effectively bridging direct primary care arrangements with traditional insurance coverage.

Why is this important

Direct primary care (DPC) is a growing alternative model where patients pay physicians directly for unlimited primary care services, often at lower costs than traditional insurance. This bill legitimizes DPC within the insurance ecosystem by ensuring patients don't face double payments—one to the DPC provider and another through their insurance plan's cost-sharing requirements. This could expand access to alternative care models while potentially reducing overall healthcare costs.

Potential points of contention

  • Insurance company concerns: Insurers may worry about reduced claim volume, inability to manage care through cost-sharing mechanisms, or difficulty calculating actuarial risk when direct payments bypass traditional billing systems
  • Definition ambiguity: The bill's effectiveness depends on clear definitions of what constitutes "direct primary care," which could create disputes about which physician arrangements qualify for credits
  • Network adequacy: Questions about whether DPC arrangements maintained outside traditional networks meet state insurance network adequacy requirements and consumer protections

Compiled from official sources — confirm details with the bill’s official record.

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