Sponsors (2)
The bill expands mandated restorative and mental-health coverage for people who had sex-rejecting procedures and reduces their out-of-pocket costs, but it raises insurer and employer costs, embeds binary legal definitions of sex that may harm transgender access, and excludes some fertility-restoration options while creating administrative disputes.
People who have undergone sex-rejecting procedures would gain mandated coverage for restorative care and treatment of related complications, including explicit coverage of mental-health and rehabilitative services (e.g., depression care, trauma counseling, speech and pelvic-floor therapy).
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 (helping low-income patients in particular).
The bill defines legal sex in strictly binary, genetically determined terms, which could conflict with nondiscrimination rules and undermine access to care for transgender and gender-diverse people.
Plans and issuers would face increased coverage obligations and costs, which could translate into higher premiums or greater employer plan costs affecting taxpayers, employers, and middle-class families.
Some fertility-restoration options are excluded when they involve handling eggs or embryos outside the body, limiting coverage for certain assisted-reproduction or fertility-restoration treatments for affected individuals.
Based on analysis of 2 sections of legislative text.
Requires plans that cover any “sex‑rejecting procedure” to also cover restorative and follow-up care for harms from such procedures with parity in cost-sharing and limits.
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 provide benefits for any “sex-rejecting procedure” to also cover items and services to address harms of those procedures (including restorative care) for people who received them, even if the original procedure was not covered by that plan. It mandates parity so cost-sharing and treatment limits for those follow-up items and services are no more restrictive than the predominant cost-sharing and treatment limits applied to substantially all medical and surgical benefits, and it bars separate rules that apply only to those services. Defines “female” and “male” using explicit biologically based language and expands the statutory meaning of “treatment limitation” to explicitly include annual and lifetime dollar or quantitative limits, while incorporating federal definitions for “financial requirement” and “predominant.”