Sponsors (4)
The bill substantially expands in‑network, no‑cost mental health and SUD coverage and continuity for pregnant and postpartum people across most plans (including via telehealth), improving access and stability—but implementation is delayed, some out‑of‑network gaps remain, and costs may be shifted to insurers and employers with potential premium or network‑narrowing consequences.
Pregnant and postpartum individuals will have $0 in‑network cost‑sharing for mental health and substance use disorder (SUD) services from pregnancy diagnosis through one year postpartum for plan years starting two years after enactment.
This protection and other provisions apply broadly across private group plans, individual market issuers, ERISA plans, and the FEHBP, extending benefits to many insured Americans.
Pregnant and postpartum patients can continue treatment with their existing mental health or SUD provider during pregnancy and for one year postpartum due to expanded continuity‑of‑care rights, improving treatment stability and outcomes.
Insurers and employers may face higher plan costs to absorb eliminated cost‑sharing, which could lead to higher premiums or greater employer contributions for taxpayers, small‑business owners, and middle‑class families.
Pregnant and postpartum individuals will not get these protections immediately because the rule applies only to plan years starting two years after enactment, delaying relief.
Patients who receive care from out‑of‑network clinicians or who face limited in‑network capacity may still incur cost‑sharing, leaving gaps in the intended financial protection.
Based on analysis of 2 sections of legislative text.
Eliminates cost‑sharing for in‑network mental health and SUD services (including telehealth) for pregnant and postpartum individuals through one year postpartum and expands continuity‑of‑care protections.
Official title: Amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to require that group health plans and health insurance issuers offering group or individual health insurance that provide coverage for mental health services and substance use disorder services provide such services without the imposition of cost-sharing from the diagnosis of pregnancy through the 1-year period following such pregnancy, and for other purposes.
Introduced January 27, 2026 by Jeanne Shaheen · Last progress January 27, 2026
Eliminates cost-sharing for in‑network mental health and substance use disorder (SUD) services, including telehealth, for pregnant and postpartum individuals from the time of pregnancy diagnosis through one year after the pregnancy’s last day. It also expands continuity‑of‑care protections so pregnant and postpartum people receiving mental health or SUD treatment can continue care by an existing provider. The changes apply to group and individual health plans subject to the PHS Act and ERISA for plan years beginning two years after enactment.