S. 5030: Treatment and Restoration Uniformity and Transparency in Health Coverage Act of 2026

This bill would require certain health insurance plans that cover “sex-rejecting procedures” to also cover related restorative care and treatment for harm caused by those procedures. It would apply to health plans governed by federal health law, including plans under the Public Health Service Act, the Employee Retirement Income Security Act (ERISA), and the Internal Revenue Code, beginning January 1, 2027.

What would be covered

If a plan covers the specified procedures, it would also have to cover related care that helps address physical or medical effects connected to those procedures. The bill sets out definitions for the procedures and for what counts as related restorative care and harm treatment.

Cost-sharing and limits

The bill says this required additional coverage must be provided on terms that are comparable to the coverage for the original procedures. That means health plans could not impose more restrictive cost-sharing, dollar limits, or other coverage limits on the restorative care and harm treatment than they apply to the covered procedures themselves.

Exclusions and scope

The bill also includes exclusions and detailed definitions to clarify when the new coverage rules apply and when they do not. Its requirements would only apply to plans that already cover the specified procedures.

Effective date

The bill would take effect for the relevant federal health coverage rules on January 1, 2027.

Relevant Companies

None found.