On April 16, 2026, Gov. Reynolds signed HF 2434, which prohibits insurers from denying coverage for covered services solely because the referring primary care provider does not participate in the insurer’s network. The legislation also prohibits an insurer from imposing higher deductibles, copayments, or coinsurance for covered services referred by an out-of-network primary care provider compared to the cost-sharing charged for services referred by an in-network primary care provider. An insurer may require evidence that the out-of-network primary care provider has executed a direct primary care arrangement with the covered enrollee. The new requirements apply to covered benefits referred by a primary care provider on or after July 1, 2026.
Employers that sponsor fully insured group health plans in Iowa should consult with their carriers and amend their plans as necessary to conform with the new legislation. The law does not apply to ERISA self-insured group health plans.
For the full text of the legislation, please see HF 2434 Text.