What This Bill Does
This bill would require group health plans and health insurance issuers offering group or individual coverage to cover 3 primary care visits and 3 behavioral health care visits each year without any cost-sharing. That means eligible enrollees could use those visits without copays, deductibles, or coinsurance for the covered appointments. The proposal would apply across employer plans and individual market coverage, and it would amend ERISA, the Public Health Service Act, and the tax code to make the requirement broadly enforceable. The goal is to lower the upfront cost of getting routine medical and mental health care.
- Requires 3 primary care visits with no cost-sharing
- Requires 3 behavioral health visits with no cost-sharing
- Applies to group health plans and health insurance issuers
- Covers both group and individual health insurance coverage
- Amends ERISA, the Public Health Service Act, and the Internal Revenue Code
Who This Bill Affects
If you have employer coverage or buy insurance on the individual market, this bill would give you up to 3 primary care visits and 3 behavioral health visits each year with no copay, deductible, or coinsurance for those visits. That could make it easier to see a doctor for routine care or get an initial mental health appointment without paying out of pocket first. The main practical effect is lower upfront costs for covered visits, though premiums could reflect some of the added expense over time.
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- Patients with high deductibles They would be able to use a limited number of essential visits without paying upfront costs, which can reduce delays in care and help people catch problems earlier.
- Mental health advocates Free behavioral health visits can make it easier for people to seek help before conditions worsen, especially for first-time evaluation or short-term treatment needs.
- Primary care clinicians Removing cost-sharing for a few visits may encourage patients to establish care, follow up on chronic conditions, and use preventive services more consistently.
- Health insurers They may argue that mandated no-cost visits add claims costs and could lead to higher premiums or tighter plan design elsewhere.
- Employers that sponsor health plans They may worry about increased benefit costs, especially for smaller firms that are sensitive to changes in premium levels.
- Budget-conscious policy analysts They may question whether a federal mandate is the best way to target access problems, since the cost of the benefit would be spread across all enrollees.
Key Implications
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““3 primary care visits … without application of any cost-sharing requirement””
Enrollees could see a doctor for a limited number of visits without paying copays, deductibles, or coinsurance for those appointments.
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““3 behavioral health care visits””
The bill creates a specific no-cost pathway for mental health or substance-use-related visits, which can lower the barrier to first contact with care.
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““group health plans and health insurance issuers””
The requirement would reach both employer-sponsored coverage and many individual-market plans, not just one segment of the insurance market.
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““amend the Employee Retirement Income Security Act of 1974””
ERISA coverage means the rule would apply to many private employer health plans, which is where a large share of Americans get insurance.
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““title XXVII of the Public Health Service Act””
This is the legal framework that governs many health insurance market rules, so the bill would be written into the federal standards insurers must follow.
Latest Status
June 11, 2026
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
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Ask AI about this billData sourced from api.congress.gov.