Sponsor
Angus Stanley King
Senator · I-ME
Senator · I-ME
The bill expands no‑cost primary and behavioral health visits and reduces administrative barriers to care, improving access for many, while increasing insurer/employer costs, adding implementation burdens, and leaving some services or HSA implications that could still expose patients to charges.
People with employer-sponsored or individual health plans gain at least three no‑cost primary care visits per year, reducing out‑of‑pocket spending for routine care and encouraging earlier treatment.
People with employer-sponsored or individual plans gain at least three no‑cost behavioral health visits per year, improving access to mental health and substance‑use services.
Patients (including those with chronic conditions) face fewer administrative barriers because plans may not impose prior authorization or separate visit‑specific limits for these visits, preserving access protections.
Plan sponsors, employers, and enrollees may face higher insurance costs because covering additional no‑cost visits increases plan expenses, which could be passed on through higher premiums or employer contributions.
Some visits may still be excluded (excepted benefits or noncovered services), so patients—particularly those with complex or chronic needs—could incur charges if a visit falls outside the defined covered services.
Amending HSA/HDP rules to allow these visits pre‑deductible could change HSA eligibility or employer plan design choices, creating confusion or reduced HSA access for some taxpayers and beneficiaries.
Based on analysis of 2 sections of legislative text.
Requires at least three no-cost primary care visits and three no-cost behavioral health visits per plan year for covered group plans and issuers, with no prior authorization and reimbursement parity.
Official title: 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 Angus Stanley King · Last progress June 11, 2026
Requires group health plans and health insurance issuers to cover at least three primary care visits and three behavioral health visits per plan year without cost-sharing, prior authorization, or visit-specific limits. It defines covered visit types and qualified providers, requires reimbursement parity with comparable visits, and applies existing ERISA and Public Health Service Act enforcement rules while excluding excepted benefits. The change is implemented by adding a new section to ERISA that extends requirements to plans and issuers subject to ERISA and the PHSA. The provision limits permitted patient charges and billing by providers and preserves existing coverage mandates under PHSA §2713.