Sponsors (2)
Official title: To amend the Employee Retirement Income Security Act of 1974, title XXVII of the Public Health Service Act, and the Internal Revenue Code of 1986 to require group health plans and health insurance issuers offering group or individual health insurance coverage to provide for 3 primary care visits and 3 behavioral health care visits without application of any cost-sharing requirement.
Introduced June 11, 2026 by Lauren Underwood · Last progress June 11, 2026
The bill expands no‑cost primary care and behavioral health visits and strengthens access protections for clinicians, improving affordability and access for many patients, but shifts costs and administrative burdens to employers, plans, and some providers and creates tax/eligibility and implementation risks that could narrow benefits in practice.
Insured people (including Medicare/Medicaid beneficiaries and those with chronic conditions) will get at least three primary care visits and at least three behavioral health visits per year with no deductibles, copays, or coinsurance, lowering out‑of‑pocket costs and improving access to routine and behavioral care.
Patients with chronic or behavioral health needs will face fewer administrative barriers because plans must treat the qualifying primary care and behavioral visits like comparable services (no stricter prior authorization or limits), enabling timelier care.
Providers offering qualifying visits are protected from being steered out of networks or discriminated against, which helps preserve patient choice and maintain access to clinicians.
Employers and plan sponsors may face higher plan costs from covering additional no‑cost visits, which could translate into higher premiums, reduced benefits elsewhere, or changes to plan offerings affecting working families and small businesses.
Some high‑deductible health plan (HSA) enrollees could lose HSA eligibility unless tax rules are adjusted, because the Internal Revenue Code definition of HDHP coverage is expanded.
Smaller primary care practices and behavioral health providers may face payment disputes, delayed reimbursements, or administrative strain as plans implement comparable in‑network rate rules and nondiscrimination contracting requirements.
Based on analysis of 2 sections of legislative text.
Requires group health plans and group-market insurers to cover at least three primary care and three behavioral health visits per year without cost-sharing and prohibits stricter management or lower reimbursement for those visits.
Requires employer-sponsored group health plans and group-market health insurers to cover, without patient cost-sharing, a set number of primary care and behavioral health visits each plan year and prohibits medical-management limits or lower reimbursement for those visits. It also sets network access and non-discrimination rules for clinicians, payment rules tied to in‑network or comparable rates, requires notice to enrollees, and directs Labor, HHS, and Treasury to issue implementing rules and enforcement guidance.