H.R. 9257: Primary and Behavioral Health Care Access Act of 2026

This bill would require most group health plans and health insurance issuers to cover three primary care visits and three behavioral health care visits each plan year without any cost-sharing. That means no copayments, deductibles, or coinsurance for those specific visits.

What counts as covered visits

The bill defines:

• Primary care visits as in-person visits to a person’s designated primary care provider, where the patient receives primary care services.
• Behavioral health care visits as visits to a qualified provider for diagnosis, treatment, screening, or prevention of a behavioral health condition.

Who would be covered

The requirement would apply to:

• Group health plans and insurers offering group coverage under ERISA.
• Group and individual health insurance coverage under the Public Health Service Act.
• Group health plans under the Internal Revenue Code.

The bill also says that certain high-deductible health plans could treat these visits as allowed services under the existing tax rules for health savings accounts.

Limits on how insurers could apply the benefit

The bill says insurers and plans could not make these three no-cost visits subject to stricter rules than other covered primary care or behavioral health visits. It also bars separate restrictions that would apply only to these visits.

For these visits, the plan would have to pay providers at the same reimbursement rates used for other covered primary care or behavioral health visits.

Who qualifies as a provider

The bill lists several types of providers that could count as qualified providers, including physicians and certain advanced practice clinicians for primary care, and a range of mental health and related professionals for behavioral health care.

When it would take effect

The changes would apply to plan years beginning two years after enactment.

Relevant Companies

None found