United States S 5030: A bill to 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.
Status: Introduced in Senate (as of 2026-07-16)
State: United States · Session: 119 · Bill: S 5030
Sponsors: Cynthia M. Lummis, Roger Marshall
Summary
This bill requires health insurance plans and issuers that cover gender-affirming medical procedures to also provide coverage for treatments addressing complications and harms from those procedures, including surgical revisions, hormone management, mental health care, and fertility services. The bill affects individuals who have undergone gender-affirming care, as well as group health plans and health insurance companies offering coverage to employees and individuals. The legislation defines "sex-rejecting procedures" broadly to include puberty blockers, hormone therapy, and various surgeries, while carving out exceptions for intersex conditions and other specified medical situations.
Bill Text
II 119THCONGRESS 2 DSESSION S. 5030 To 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 bene- fits 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 practicable. IN THE SENATE OF THE UNITED STATES JULY16, 2026 Mr. M ARSHALL(for himself and Ms. LUMMIS) introduced the following bill; which was read twice and referred to the Committee on Health, Edu- cation, Labor, and Pensions A BILL To 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 ben- efits 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 practicable. Be it enacted by the Senate and House of Representa-1 tives of the United States of America in Congress assembled, 2 VerDate Sep 11 2014 02:42 Jul 17, 2026 Jkt 069200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S5030.IS S5030 kjohnson on DSK7ZCZBW3PROD with $$_JOB 2 •S 5030 IS SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Treatment and Res-2 toration Uniformity and Transparency in Health Coverage 3 Act of 2026’’ or the ‘‘TRUTH in Coverage Act of 2026’’. 4 SEC. 2. REQUIRING GROUP HEALTH PLANS AND HEALTH 5 INSURANCE ISSUERS OFFERING GROUP OR 6 INDIVIDUAL HEALTH INSURANCE COVERAGE 7 THAT PROVIDE BENEFITS FOR SEX-REJECT-8 ING PROCEDURES TO PROVIDE BENEFITS 9 FOR ITEMS AND SERVICES TO ADDRESS THE 10 HARMS OF SUCH PROCEDURES. 11 (a) PHSA.—Part D of title XXVII of the Public 12 Health Service Act (42 U.S.C. 300gg–111 et seq.) is 13 amended by adding at the end the following new section: 14 ‘‘SEC. 2799A–12. REQUIRED COVERAGE OF ITEMS AND SERV-15 ICES TO ADDRESS THE HARMS OF SEX-RE-16 JECTING PROCEDURES. 17 ‘‘(a) I NGENERAL.—A group health plan and a health 18 insurance issuer offering group or individual health insur-19 ance coverage shall, in the case such plan or coverage pro-20 vides benefits with respect to any sex-rejecting procedure, 21 also provide benefits for items and services furnished to 22 an individual who has received any such procedure to ad-23 dress the harms of such procedure (including restorative 24 care), regardless of whether— 25 VerDate Sep 11 2014 02:42 Jul 17, 2026 Jkt 069200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S5030.IS S5030 kjohnson on DSK7ZCZBW3PROD with $$_JOB 3 •S 5030 IS ‘‘(1) such individual received benefits with re-1 spect to the sex-rejecting procedure under the indi-2 vidual’s plan or coverage; or 3 ‘‘(2) such plan or issuer provides benefits under 4 the individual’s plan or coverage for the sex-rejecting 5 procedure. 6 ‘‘(b) A PPLICATION OFFINANCIALREQUIREMENTS 7 ANDTREATMENTLIMITATIONS.—A group health plan 8 and a health insurance issuer offering group or individual 9 health insurance coverage shall ensure that, with respect 10 to items and services for which benefits to address the 11 harms of sex-rejecting procedures are required to be pro-12 vided under such plan or coverage under subsection (a)— 13 ‘‘(1) the financial requirements applicable to 14 such items and services are no more restrictive than 15 the predominant financial requirements applied to 16 substantially all medical and surgical benefits cov-17 ered by the plan or coverage and there are no sepa-18 rate cost-sharing requirements that are applicable 19 only with respect to such items and services; and 20 ‘‘(2) the treatment limitations applicable to 21 such items and services are no more restrictive than 22 the predominant treatment limitations applied to 23 substantially all medical and surgical benefits cov-24 ered by the plan or coverage and there are no sepa-25 VerDate Sep 11 2014 02:42 Jul 17, 2026 Jkt 069200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S5030.IS S5030 kjohnson on DSK7ZCZBW3PROD with $$_JOB 4 •S 5030 IS rate treatment limitations that are appl
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