Sponsors (2)
The bill expands guaranteed restorative, mental‑health, and rehabilitative coverage and limits out‑of‑pocket costs for people who received sex‑rejecting procedures, but it does so using rigid biological definitions and prescriptive coverage rules that could raise plan costs, spur administrative disputes, and exclude some fertility treatments.
People who previously received sex‑rejecting procedures will gain guaranteed coverage for restorative care and treatment of complications even when the original procedure wasn’t covered.
Cost-sharing and limits for restorative services must be no more restrictive than predominant medical/surgical benefits, reducing out‑of‑pocket costs for affected patients (including low‑income individuals).
Mental‑health and rehabilitative services tied to procedure‑associated conditions (depression, trauma, speech therapy, pelvic‑floor therapy) are explicitly covered, improving access to comprehensive follow‑up care.
Health plans and insurers would face expanded coverage obligations that could increase their costs and lead to higher premiums or higher employer plan costs, affecting taxpayers and middle‑class families.
The bill codifies binary, genetically based legal definitions of “male” and “female” (sex determined at fertilization), which could conflict with existing nondiscrimination interpretations and negatively affect access to care for trans and other gender‑diverse people.
Broad, prescriptive definitions of “sex‑rejecting procedures” and related exclusions may create administrative complexity and disputes over coverage scope and medical necessity for providers, hospitals, and insurers.
Based on analysis of 2 sections of legislative text.
Requires plans that cover any sex‑rejecting procedure to also cover treatment for harms of those procedures with parity in cost‑sharing and limits, and adds biologically based sex definitions.
Official title: Amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to require group health plans and health insurance issuers offering group or individual health insurance coverage that provide benefits for sex-rejecting procedures to provide benefits for items and services to address the harms caused by sex-rejecting procedures and to restore healthy human form and functioning, to the greatest extent possible.
Introduced July 16, 2026 by Roger Wayne Marshall · Last progress July 16, 2026
Requires group health plans and health insurance issuers that cover any "sex-rejecting procedure" to also cover items and services to treat harms from those procedures, including restorative care, regardless of whether the original procedure was covered by the same plan. It mandates parity so cost-sharing and treatment limits for those follow-up services cannot be more restrictive than the predominant financial requirements and limits that apply to substantially all medical and surgical benefits, and forbids separate rules that apply only to those services. Defines “male” and “female” using explicit biological descriptions tied to gamete production at maturity and expands the statutory meaning of "treatment limitation" to explicitly include annual and lifetime dollar or quantitative limits. Also incorporates existing statutory terms for "financial requirement" and "predominant."