Pennsylvania HB 2096: An Act providing for direct primary care, medical service agreements and insurance, for medical service agreement requirements, for use of health savings accounts or flexible spending accounts and for use of other health care practitioners.

Bill Text

PRINTER'S NO. 2692
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 2096
Session of
2025
INTRODUCED BY GROVE, PICKETT AND KAUFFMAN, DECEMBER 9, 2025
REFERRED TO COMMITTEE ON INSURANCE, DECEMBER 9, 2025
AN ACT
Providing for direct primary care, medical service agreements
and insurance, for medical service agreement requirements,
for use of health savings accounts or flexible spending
accounts and for use of other health care practitioners.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Short title.
This act shall be known and may be cited as the Medical
Service Agreement Act.
Section 2. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Department." The Insurance Department of the Commonwealth.
"Direct fee." A fee charged by a physician to a patient or a
patient's designee for primary medical care services provided
by, or to be provided by, the physician to the patient. The term
includes a fee in any form, including any of the following:
(1) A monthly retainer.
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(2) A membership fee.
(3) A subscription fee.
(4) A fee paid under a medical service agreement.
(5) A fee for a service, visit or episode of care.
"Direct primary care." A primary medical care service
provided by a physician to a patient in return for payment in
accordance with a direct fee.
"Health care practitioner." An individual who is authorized
to practice some component of the healing arts by a license,
permit, certificate or registration issued by a Commonwealth
licensing agency or board.
"Medical service agreement." A signed written agreement
under which a physician agrees to provide direct primary care
services to a patient for a period of time in exchange for a
direct fee and which is entered into by the physician and any of
the following:
(1) The patient.
(2) The patient's legal representative, guardian or
employer on behalf of the patient.
(3) The legal representative of the patient's employer
or guardian on behalf of the patient.
"Physician." A person licensed to practice medicine in this
Commonwealth. The term includes medical doctors and doctors of
osteopathy.
"Primary medical care service." A routine or general health
care service of the type provided at the time a patient seeks
preventive care or first seeks health care services for a
specific health concern and is a patient's main source for
regular health care services. The term includes health care
services provided for any of the following purposes:
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(1) Promoting and maintaining mental and physical health
and wellness.
(2) Preventing disease.
(3) Screening, diagnosing and treating acute or chronic
conditions caused by disease, injury or illness.
(4) Providing patient counseling and education.
(5) Providing a broad spectrum of preventive and
curative health care over a period of time.
Section 3. Direct primary care, medical service agreements and
insurance.
(a) Direct primary care.--A physician providing direct
primary care based on a medical service agreement shall not be
considered an insurer or health maintenance organization under
the laws of this Commonwealth, and the physician shall not be
subject to regulation by the department for direct primary care.
(b) Medical service agreements.--A medical service agreement
shall not be considered health or accident insurance or coverage
under 40 Pa.C.S. (relating to insurance) and shall not be
subject to regulation by the department.
(c) Physicians.--A physician shall not be required to obtain
a certificate of authority under 40 Pa.C.S. to market, sell or
offer a medical service agreement or provide direct primary
care.
Section 4. Medical service agreement requirements.
In order to be considered a medical service agreement under
this act, the medical service agreement shall:
(1) be in writing;
(2) be signed by the patient or patient's legal
representative or guardian;
(3) be signed by the physician;
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(4) allow either party to terminate the medical service
agreement upon written notice to the other party;
(5) describe the specific health care services that are
included in the medical service agreement;
(6) specify the fee for the medical service agreement;
(7) specify the period of time under the medical service
agreement; and
(8) include the following statement:
This agreement does not provide comprehensive health
insurance coverage. This agreement only provides for
the health care services specifically described.
Section 5. Use of health savings accounts or flexible spending
accounts.
If a patient enters into a medical service agreement under
this act, fees under the medical service agreement may be paid
or reimb