Mandated “Free” Visits: Is Congress About to Rewrite Your 2027 Plan Design?

TJ Bullock | June 21st, 2026

For years, the "High Deductible Health Plan" (HDHP) has been the go-to survival tactic for mid-market business owners. It was the only way to keep premiums from looking like a mortgage payment. But there was always a catch: your employees were essentially "uninsured" for the first $5,000, $7,000, or even $10,000 of care.

They weren't just skipping the doctor; they were hiding from them.

Now, Congress is looking to flip the script. The Primary and Behavioral Healthcare Access Act, reintroduced in mid-2026, aims to force a "safety net" into every employer plan. If it passes, your 2027 plan design might be legally required to provide 6 "free" visits before the deductible even blinks.

As your local group health insurance broker, we’re seeing this as a potential sea change for how you pay for your benefits. Let’s break down what’s actually happening and why your "catastrophic" shield might be getting a makeover.

The "3 + 3" Rule: What’s in the Bill?

The math behind the Primary and Behavioral Healthcare Access Act is simple, but the impact is massive. The bill requires all commercial health plans: including those used by businesses with 25–300 employees: to cover:

1. 3 Primary Care Visits: Zero cost-sharing. No copay. No coinsurance. No deductible.
2. 3 Behavioral Health Visits: The same rules apply to outpatient mental health or addiction treatment.

That is six touchpoints with a medical professional that the employer (or the insurance carrier) pays for in full, regardless of how high the employee's deductible is.

For a small business owner, this looks like another unfunded mandate. But for a health benefits consultant, it looks like a necessary correction.

Why Congress is Pushing for "Free"

The logic being used by lawmakers like Rep. Lauren Underhill and Sen. Angus King is one we’ve championed at Bullock & Associates for years: Early detection is cheaper than a catastrophic claim.

When an employee with a $5,000 deductible feels a weird pain in their chest, they don't call a primary care doctor. They wait. They wait until that pain becomes a $150,000 heart attack that hits your claims experience like a freight train.

By mandating "free" visits, Congress is trying to lower the barrier to entry for maintenance care. It’s an attempt to stop the "High Deductible Burnout" that has led many employees to view their insurance as a "useless" benefit until they’re in the ER.

The ERISA Factor: Is My Self-Insured Plan Safe?

Usually, when the government starts throwing around new mandates, self-insured employers (those under ERISA) have a bit of a shield. ERISA preemption often protects self-funded plans from state-level mandates.

Not this time.

This bill specifically targets the Employee Retirement Income Security Act. If passed, it would apply to:

• Fully Insured Plans: Your standard carrier-packaged plans.
• Self-Insured Plans: Even those custom-built, unique funding solutions.

If you are working with a health insurance broker near me to build a self-funded model, this mandate won't necessarily break your budget: but it will require a "plan design audit." You can't just set a $10,000 deductible and call it a day anymore. You have to account for these six "first-dollar" exposures.

"It’s Not Your Plan, It’s How You’re Paying For It"

At Bullock & Associates, our motto is "Making Complicated Simple." When a new mandate like this hits the horizon, most brokers start looking for ways to raise deductibles even further to offset the cost.

We don't.

We believe the problem isn't the mandated visits; it's how you’re funding them. If this bill passes, the "old way" of insurance (just paying higher premiums for better access) is going to get even more expensive.

Instead, mid-market employers should be looking at unique funding solutions. For example:

• HRA Integration: Using a Health Reimbursement Arrangement to cover those six visits specifically, rather than baking them into a high-premium PPO.
• DPC (Direct Primary Care) Wraps: Many employers are already providing "unlimited" primary care through DPC memberships, which effectively bypasses the need for these mandates altogether.
• Strategic HSA Education: Helping employees understand that Health Savings Accounts are for the "everyday" and the insurance is for the "major," while the mandate fills the gap in between.

The Behavioral Health Crisis in the Workplace

The inclusion of three "free" mental health visits is perhaps the most significant part of this legislation. Since 2020, behavioral health claims have skyrocketed. For businesses with 25-300 employees, mental health isn't just a "nice-to-have" benefit; it’s a productivity issue.

When employees can’t afford to see a therapist because they haven’t met their $6,000 deductible, they don't just "get over it." They stop showing up, or they show up and perform at 50%.

By mandating access to behavioral health, Congress is forcing employers to address a recruitment and retention issue that has been hurting the bottom line for years.

Is This the End of the HDHP?

Hardly. But it is the end of the "Set It and Forget It" HDHP.

If your employee benefits consulting services provider is just handing you a spreadsheet with three slightly different versions of a BlueCross or Cigna plan, they aren't preparing you for 2027.

You need a strategy that understands the nuances of the Primary and Behavioral Healthcare Access Act. If the government is going to mandate six visits, you need to find a way to fund those visits that doesn't involve your renewal rate jumping another 15%.

Audit Your Plan Design Now

We don’t wait for the law to pass to start planning. If you have between 25 and 300 employees, now is the time to look at your current claims data.

• How many of your employees are already using 3+ primary care visits?
• How much of your current "spend" is tied up in routine behavioral health?
• Are you currently using a Self-Funding Certification expert to look for holes in your coverage?

Providing small business health insurance is getting more complicated by the day. But at Bullock & Associates, we believe that people should understand their benefits: and that employers shouldn't have to sacrifice their profitability to provide them.

Congress might be rewriting the rules for 2027, but they aren't the ones paying the bill. You are. Let’s make sure you’re paying it the right way.

Making Complicated Simple.

#UBA #NABIP #employeebenefits #HealthInsurance #Congress #PrimaryCare #MentalHealth #PlanDesign

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