[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9743 Introduced in House (IH)]
<DOC>
119th CONGRESS
2d Session
H. R. 9743
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
practicable.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 16, 2026
Mrs. Harshbarger (for herself, Mr. Carter of Georgia, Mr. McGuire, Mr.
Kennedy of Utah, Mr. Carter of Texas, Mr. Fuller, Mr. Van Epps, Mrs.
Biggs of South Carolina, Mr. Babin, Mrs. Miller of Illinois, Mr.
Stutzman, Mr. Hamadeh of Arizona, and Mr. Ciscomani) introduced the
following bill; which was referred to the Committee on Energy and
Commerce, and in addition to the Committees on Education and Workforce,
and Ways and Means, for a period to be subsequently determined by the
Speaker, in each case for consideration of such provisions as fall
within the jurisdiction of the committee concerned
_______________________________________________________________________
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
practicable.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Treatment and Restoration Uniformity
and Transparency in Health Coverage Act of 2026'' or the ``TRUTH in
Coverage Act of 2026''.
SEC. 2. REQUIRING 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 OF SUCH PROCEDURES.
(a) PHSA.--Part D of title XXVII of the Public Health Service Act
(42 U.S.C. 300gg-111 et seq.) is amended by adding at the end the
following new section:
``SEC. 2799A-12. REQUIRED COVERAGE OF ITEMS AND SERVICES TO ADDRESS THE
HARMS OF SEX-REJECTING PROCEDURES.
``(a) In General.--A group health plan and a health insurance
issuer offering group or individual health insurance coverage shall, in
the case such plan or coverage provides benefits with respect to any
sex-rejecting procedure, also provide benefits for items and services
furnished to an individual who has received any such procedure to
address the harms of such procedure (including restorative care),
regardless of whether--
``(1) such individual received benefits with respect to the
sex-rejecting procedure under the individual's plan or
coverage; or
``(2) such plan or issuer provides benefits under the
individual's plan or coverage for the sex-rejecting procedure.
``(b) Application of Financial Requirements and Treatment
Limitations.--A group health plan and a health insurance issuer
offering group or individual health insurance coverage shall ensure
that, with respect to items and services for which benefits to address
the harms of sex-rejecting procedures are required to be provided under
such plan or coverage under subsection (a)--
``(1) the financial requirements applicable to such items
and services are no more restrictive than the predominant
financial requirements applied to substantially all medical and
surgical benefits covered by the plan or coverage and there are
no separate cost-sharing requirements that are applicable only
with respect to such items and services; and
``(2) the treatment limitations applicable to such items
and services are no more restrictive than the predominant
treatment limitations applied to substantially all medical and
surgical benefits covered by the plan or coverage and there are
no separate treatment limitations that are applicable only with
respect to such items and services.
``(c) Definitions.--In this section:
``(1) Female.--Referring to a natural person, the term
`female' means an individual characterized by a reproductive
system naturally organized to produce (at maturity, absent
disruption or congenital anomaly) large gametes (ova).
``(2) Financial requirement; predominant; treatment
limitation.--The terms `financial requirement', `predominant',
and `treatment limitation' have the meaning given such terms in
clauses (i) through (iii), respectively, of section
2726(a)(3)(B), except that the term `financial requirement'
shall include aggregate lifetime limits and annual limits.
``(3) Male.--Referring to a natural person, the term `male'
means an individual characterized by a reproductive system
naturally organized to produce (at maturity, absent disruption
or congenital anomaly) small gametes (sperm).
``(4) Restorative care.--The term `restorative care' means
items and services furnished to an individual who has received
any sex-rejecting procedure at any point during the
individual's lifetime to address, mitigate, monitor, treat, or
reverse the harms, complications, and adverse effects of such
procedure, including interventions intended to restore, to the
greatest extent practicable, healthy human form and
functioning. Such care includes items and services furnished to
address--
``(A) impaired reproductive capacity, diminished
ovarian reserve, impaired spermatogenesis, or other
reproductive-system injury;
``(B) endocrine dysfunction, hormonal imbalance,
hypogonadism, dependence on exogenous hormones, or
other disruption of healthy endocrine function;
``(C) impaired sexual function, including loss of
sexual sensation, anorgasmia, erectile dysfunction,
genital pain, vaginal stenosis, diminished libido, or
other sexual dysfunction;
``(D) urinary dysfunction, including urinary
incontinence, urinary retention, urethral
complications, recurrent urinary tract infections, or
other genitourinary injury;
``(E) resultant vocal cord damage, permanent voice
changes, vocal dysfunction, or impaired speech;
``(F) female hirsutism, male-pattern baldness,
breast atrophy, breast development, or other secondary-
sex-characteristic changes caused by cross-sex
hormones;
``(G) osteoporosis, osteopenia, impaired bone
development, fractures, reduced bone density, or other
skeletal disorders associated with puberty suppression
or cross-sex hormone use;
``(H) cardiovascular disease, thromboembolic
disease, hypertension, stroke, myocardial infarction,
metabolic syndrome, diabetes, or other cardiovascular
or metabolic complications associated with such
procedures;
``(I) surgical complications, including infection,
fistula formation, stenosis, tissue necrosis, chronic
pain, nerve damage, graft failure, implant
complications, wound complications, or the need for
revision surgery;
``(J) loss, removal, alteration, or impairment of
healthy reproductive organs, breasts, genital
structures, or other healthy tissues;
``(K) reconstructive, regenerative, prosthetic,
plastic, or other surgical interventions intended to
restore healthy anatomy, appearance, or physiological
function;
``(L) rehabilitation services, including speech
therapy, physical therapy, occupational therapy, pelvic
floor therapy, sexual health counseling, and other
therapies intended to restore healthy functioning;
``(M) psychiatric or psychological conditions
associated with or exacerbated by such procedures,
including depression, anxiety, trauma, suicidality,
grief, regret, identity distress, body-image
disturbance, or dissociation;
``(N) diagnostic testing, specialist evaluations,
fertility assessments, hormone monitoring, cancer
screening, and long-term medical surveillance
necessitated by altered anatomy or prior exposure to
puberty blockers, cross-sex hormones, or sex-rejecting
surgeries;
``(O) fertility services that seek to cooperate
with, or restore the healthy physiology and anatomy of,
the human reproductive system, without the use of
methods that circumvent natural human functions, such
as any treatments or procedures that involve the
handling of a human egg or embryo outside the body;
``(P) breast cancer in men on estrogen and certain
cancers in women on testosterone; and
``(Q) any other physical, psychological,
reproductive, endocrine, neurologic, cardiovascular,
musculoskeletal, or metabolic injury, impairment,
complication, or condition resulting from or associated
with a sex-rejecting procedure.
``(5) Sex.--The term `sex', when referring to an
individual's sex, means to refer to either male or female, as
genetically determined at fertilization.
``(6) Sex-rejecting procedure.--
``(A) In general.--The term `sex-rejecting
procedure' means any medical or surgical intervention
for the purpose of attempting to align an individual's
physical appearance or body with an asserted identity
that differs from the individual's sex, including--
``(i) gonadotropin-releasing hormone (GnRH)
agonists or any other puberty-blocking or
suppressing drugs to stop or delay normal
puberty;
``(ii) testosterone, dihydrotestosterone
(DHT), or other androgens, estrogen,
progesterone, to an individual at doses that
are supraphysiologic to what would normally be
produced endogenously in a healthy individual
of the same age and sex, as well as anti-
androgen medications;
``(iii) castration;
``(iv) orchiectomy;
``(v) scrotoplasty;
``(vi) implantation of erection or
testicular prostheses;
``(vii) vasectomy;
``(viii) hysterectomy;
``(ix) oophorectomy;
``(x) ovariectomy;
``(xi) reconstruction of the fixed part of
the urethra with or without a metoidioplasty or
a phalloplasty;
``(xii) metoidioplasty;
``(xiii) penectomy;
``(xiv) phalloplasty;
``(xv) vaginoplasty;
``(xvi) clitoroplasty;
``(xvii) vaginectomy;
``(xviii) vulvoplasty;
``(xix) reduction thyrochondroplasty;
``(xx) chondrolaryngoplasty;
``(xxi) mastectomy;
``(xxii) tubal ligation;
``(xxiii) sterilization;
``(xxiv) any plastic, cosmetic, or
aesthetic surgery that feminizes or
masculinizes the facial or other physiological
features of an individual;
``(xxv) any placement of chest implants to
create feminine breasts;
``(xxvi) any placement of fat or artificial
implants in the gluteal region;
``(xxvii) augmentation mammoplasty;
``(xxviii) liposuction;
``(xxix) lipofilling;
``(xxx) voice surgery;
``(xxxi) hair reconstruction;
``(xxxii) pectoral implants; and
``(xxxiii) the removal of any otherwise
healthy or non-diseased body part or tissue.
``(B) Exceptions.--The term `sex-rejecting
procedure' does not include the following when
furnished by a health care professional with the
consent of such individual or, if applicable, such
individual's parents or legal guardian:
``(i) Services to individuals born with a
medically verifiable disorder of sex
development, including an individual with
external sex characteristics that are
irresolvably ambiguous, such as an individual
born with 46,XX chromosomes with virilization,
an individual born with 46,XY chromosomes with
undervirilization, or an individual born having
both ovarian and testicular tissue.
``(ii) Services provided when a physician
has otherwise diagnosed a disorder of sex
development in which the physician has
determined through genetic or biochemical
testing that the individual does not have
healthy sex chromosome structure, sex steroid
hormone production, or sex steroid hormone
action for a healthy individual of the same sex
and age.
``(iii) The treatment of any infection,
injury, disease, or disorder that has been
caused by or exacerbated by the performance of
sex-rejecting procedures, whether or not the
sex-rejecting procedure was performed in
accordance with State and Federal law and
whether or not funding for the procedure is
permissible under this section.
``(iv) Any procedure undertaken because the
individual suffers from a physical disorder,
physical injury, or physical illness (but not
claimed mental distress) that would, as
certified by a physician, place the individual
in imminent danger of death or impairment of
major bodily function, unless the procedure is
performed.
``(v) Puberty suppression or blocking
prescription drugs for the purpose of
normalizing puberty for a minor experiencing
precocious puberty.
``(vi) Male circumcision.''.
(b) ERISA.--
(1) In general.--Subpart B of part 7 of subtitle B of title
I of the Employee Retirement Income Security Act of 1974 (29
U.S.C. 1185 et seq.) is amended by adding at the end the
following new section:
``SEC. 727. REQUIRED COVERAGE OF ITEMS AND SERVICES TO ADDRESS THE
HARMS OF SEX-REJECTING PROCEDURES.
``(a) In General.--A group health plan and a health insurance
issuer offering group health insurance coverage shall, in the case such
plan or coverage provides benefits with respect to any sex-rejecting
procedure, also provide benefits for items and services furnished to an
individual who has received any such procedure to address the harms of
such procedure (including restorative care), regardless of whether--
``(1) such individual received benefits with respect to the
sex-rejecting procedure under the individual's plan or
coverage; or
``(2) such plan or issuer provides benefits under the
individual's plan or coverage for the sex-rejecting procedure.
``(b) Application of Financial Requirements and Treatment
Limitations.--A group health plan and a health insurance issuer
offering group health insurance coverage shall ensure that, with
respect to items and services for which benefits to address the harms
of sex-rejecting procedures are required to be provided under such plan
or coverage under subsection (a)--
``(1) the financial requirements applicable to such items
and services are no more restrictive than the predominant
financial requirements applied to substantially all medical and
surgical benefits covered by the plan or coverage and there are
no separate cost-sharing requirements that are applicable only
with respect to such items and services; and
``(2) the treatment limitations applicable to such items
and services are no more restrictive than the predominant
treatment limitations applied to substantially all medical and
surgical benefits covered by the plan or coverage and there are
no separate treatment limitations that are applicable only with
respect to such items and services.
``(c) Definitions.--In this section:
``(1) Female.--Referring to a natural person, the term
`female' means an individual characterized by a reproductive
system naturally organized to produce (at maturity, absent
disruption or congenital anomaly) large gametes (ova).
``(2) Financial requirement; predominant; treatment
limitation.--The terms `financial requirement', `predominant',
and `treatment limitation' have the meaning given such terms in
clauses (i) through (iii), respectively, of section
712(a)(3)(B), except that the term `financial requirement'
shall include aggregate lifetime limits and annual limits.
``(3) Male.--Referring to a natural person, the term `male'
means an individual characterized by a reproductive system
naturally organized to produce (at maturity, absent disruption
or congenital anomaly) small gametes (sperm).
``(4) Restorative care.--The term `restorative care' means
items and services furnished to an individual who has received
any sex-rejecting procedure at any point during the
individual's lifetime to address, mitigate, monitor, treat, or
reverse the harms, complications, and adverse effects of such
procedure, including interventions intended to restore, to the
greatest extent practicable, healthy human form and
functioning. Such care includes items and services furnished to
address--
``(A) impaired reproductive capacity, diminished
ovarian reserve, impaired spermatogenesis, or other
reproductive-system injury;
``(B) endocrine dysfunction, hormonal imbalance,
hypogonadism, dependence on exogenous hormones, or
other disruption of healthy endocrine function;
``(C) impaired sexual function, including loss of
sexual sensation, anorgasmia, erectile dysfunction,
genital pain, vaginal stenosis, diminished libido, or
other sexual dysfunction;
``(D) urinary dysfunction, including urinary
incontinence, urinary retention, urethral
complications, recurrent urinary tract infections, or
other genitourinary injury;
``(E) resultant vocal cord damage, permanent voice
changes, vocal dysfunction, or impaired speech;
``(F) female hirsutism, male-pattern baldness,
breast atrophy, breast development, or other secondary-
sex-characteristic changes caused by cross-sex
hormones;
``(G) osteoporosis, osteopenia, impaired bone
development, fractures, reduced bone density, or other
skeletal disorders associated with puberty suppression
or cross-sex hormone use;
``(H) cardiovascular disease, thromboembolic
disease, hypertension, stroke, myocardial infarction,
metabolic syndrome, diabetes, or other cardiovascular
or metabolic complications associated with such
procedures;
``(I) surgical complications, including infection,
fistula formation, stenosis, tissue necrosis, chronic
pain, nerve damage, graft failure, implant
complications, wound complications, or the need for
revision surgery;
``(J) loss, removal, alteration, or impairment of
healthy reproductive organs, breasts, genital
structures, or other healthy tissues;
``(K) reconstructive, regenerative, prosthetic,
plastic, or other surgical interventions intended to
restore healthy anatomy, appearance, or physiological
function;
``(L) rehabilitation services, including speech
therapy, physical therapy, occupational therapy, pelvic
floor therapy, sexual health counseling, and other
therapies intended to restore healthy functioning;
``(M) psychiatric or psychological conditions
associated with or exacerbated by such procedures,
including depression, anxiety, trauma, suicidality,
grief, regret, identity distress, body-image
disturbance, or dissociation;
``(N) diagnostic testing, specialist evaluations,
fertility assessments, hormone monitoring, cancer
screening, and long-term medical surveillance
necessitated by altered anatomy or prior exposure to
puberty blockers, cross-sex hormones, or sex-rejecting
surgeries;
``(O) fertility services that seek to cooperate
with, or restore the healthy physiology and anatomy of,
the human reproductive system, without the use of
methods that circumvent natural human functions, such
as any treatments or procedures that involve the
handling of a human egg or embryo outside the body;
``(P) breast cancer in men on estrogen and certain
cancers in women on testosterone; and
``(Q) any other physical, psychological,
reproductive, endocrine, neurologic, cardiovascular,
musculoskeletal, or metabolic injury, impairment,
complication, or condition resulting from or associated
with a sex-rejecting procedure.
``(5) Sex.--The term `sex', when referring to an
individual's sex, means to refer to either male or female, as
genetically determined at fertilization.
``(6) Sex-rejecting procedure.--
``(A) In general.--The term `sex-rejecting
procedure' means any medical or surgical intervention
for the purpose of attempting to align an individual's
physical appearance or body with an asserted identity
that differs from the individual's sex, including--
``(i) gonadotropin-releasing hormone (GnRH)
agonists or any other puberty-blocking or
suppressing drugs to stop or delay normal
puberty;
``(ii) testosterone, dihydrotestosterone
(DHT), or other androgens, estrogen,
progesterone, to an individual at doses that
are supraphysiologic to what would be produced
endogenously in a healthy individual of the
same age and sex, as well as anti-androgen
medications;
``(iii) castration;
``(iv) orchiectomy;
``(v) scrotoplasty;
``(vi) implantation of erection or
testicular prostheses;
``(vii) vasectomy;
``(viii) hysterectomy;
``(ix) oophorectomy;
``(x) ovariectomy;
``(xi) reconstruction of the fixed part of
the urethra with or without a metoidioplasty or
a phalloplasty;
``(xii) metoidioplasty;
``(xiii) penectomy;
``(xiv) phalloplasty;
``(xv) vaginoplasty;
``(xvi) clitoroplasty;
``(xvii) vaginectomy;
``(xviii) vulvoplasty;
``(xix) reduction thyrochondroplasty;
``(xx) chondrolaryngoplasty;
``(xxi) mastectomy;
``(xxii) tubal ligation;
``(xxiii) sterilization;
``(xxiv) any plastic, cosmetic, or
aesthetic surgery that feminizes or
masculinizes the facial or other physiological
features of an individual;
``(xxv) any placement of chest implants to
create feminine breasts;
``(xxvi) any placement of fat or artificial
implants in the gluteal region;
``(xxvii) augmentation mammoplasty;
``(xxviii) liposuction;
``(xxix) lipofilling;
``(xxx) voice surgery;
``(xxxi) hair reconstruction;
``(xxxii) pectoral implants; and
``(xxxiii) the removal of any otherwise
healthy or non-diseased body part or tissue.
``(B) Exceptions.--The term `sex-rejecting
procedure' does not include the following when
furnished by a health care professional with the
consent of such individual or, if applicable, such
individual's parents or legal guardian:
``(i) Services to individuals born with a
medically verifiable disorder of sex
development, including an individual with
external sex characteristics that are
irresolvably ambiguous, such as an individual
born with 46,XX chromosomes with virilization,
an individual born with 46,XY chromosomes with
undervirilization, or an individual born having
both ovarian and testicular tissue.
``(ii) Services provided when a physician
has otherwise diagnosed a disorder of sex
development in which the physician has
determined through genetic or biochemical
testing that the individual does not have
healthy sex chromosome structure, sex steroid
hormone production, or sex steroid hormone
action for a healthy individual of the same sex
and age.
``(iii) The treatment of any infection,
injury, disease, or disorder that has been
caused by or exacerbated by the performance of
sex-rejecting procedures, whether or not the
sex-rejecting procedure was performed in
accordance with State and Federal law and
whether or not funding for the procedure is
permissible under this section.
``(iv) Any procedure undertaken because the
individual suffers from a physical disorder,
physical injury, or physical illness (but not
claimed mental distress) that would, as
certified by a physician, place the individual
in imminent danger of death or impairment of
major bodily function, unless the procedure is
performed.
``(v) Puberty suppression or blocking
prescription drugs for the purpose of
normalizing puberty for a minor experiencing
precocious puberty.
``(vi) Male circumcision.''.
(2) Clerical amendment.--The table of contents in section 1
of the Employee Retirement Income Security Act of 1974 (29
U.S.C. 1001 note) is amended by inserting after the item
relating to section 726 the following new item:
``Sec. 727. Required coverage of items and services to address the
harms of sex-rejecting procedures.''.
(c) IRC.--
(1) In general.--Subchapter B of chapter 100 of the
Internal Revenue Code of 1986 is amended by adding at the end
the following new section:
``SEC. 9827. REQUIRED COVERAGE OF ITEMS AND SERVICES TO ADDRESS THE
HARMS OF SEX-REJECTING PROCEDURES.
``(a) In General.--A group health plan shall, in the case such plan
provides benefits with respect to any sex-rejecting procedure, also
provide benefits for items and services furnished to an individual who
has received any such procedure to address the harms of such procedure
(including restorative care), regardless of whether--
``(1) such individual received benefits with respect to the
sex-rejecting procedure under the individual's plan; or
``(2) such plan provides benefits under the individual's
plan for the sex-rejecting procedure.
``(b) Application of Financial Requirements and Treatment
Limitations.--A group health plan shall ensure that, with respect to
items and services for which benefits to address the harms of sex-
rejecting procedures are required to be provided under such plan under
subsection (a)--
``(1) the financial requirements applicable to such items
and services are no more restrictive than the predominant
financial requirements applied to substantially all medical and
surgical benefits covered by the plan and there are no separate
cost-sharing requirements that are applicable only with respect
to such items and services; and
``(2) the treatment limitations applicable to such items
and services are no more restrictive than the predominant
treatment limitations applied to substantially all medical and
surgical benefits covered by the plan and there are no separate
treatment limitations that are applicable only with respect to
such items and services.
``(c) Definitions.--In this section:
``(1) Female.--Referring to a natural person, the term
`female' means an individual characterized by a reproductive
system naturally organized to produce (at maturity, absent
disruption or congenital anomaly) large gametes (ova).
``(2) Financial requirement; predominant; treatment
limitation.--The terms `financial requirement', `predominant',
and `treatment limitation' have the meaning given such terms in
clauses (i) through (iii), respectively, of section
9812(a)(3)(B), except that the term `financial requirement'
shall include aggregate lifetime limits and annual limits.
``(3) Male.--Referring to a natural person, the term `male'
means an individual characterized by a reproductive system
naturally organized to produce (at maturity, absent disruption
or congenital anomaly) small gametes (sperm).
``(4) Restorative care.--The term `restorative care' means
items and services furnished to an individual who has received
any sex-rejecting procedure at any point during the
individual's lifetime to address, mitigate, monitor, treat, or
reverse the harms, complications, and adverse effects of such
procedure, including interventions intended to restore, to the
greatest extent practicable, healthy human form and
functioning. Such care includes items and services furnished to
address--
``(A) impaired reproductive capacity, diminished
ovarian reserve, impaired spermatogenesis, or other
reproductive-system injury;
``(B) endocrine dysfunction, hormonal imbalance,
hypogonadism, dependence on exogenous hormones, or
other disruption of healthy endocrine function;
``(C) impaired sexual function, including loss of
sexual sensation, anorgasmia, erectile dysfunction,
genital pain, vaginal stenosis, diminished libido, or
other sexual dysfunction;
``(D) urinary dysfunction, including urinary
incontinence, urinary retention, urethral
complications, recurrent urinary tract infections, or
other genitourinary injury;
``(E) resultant vocal cord damage, permanent voice
changes, vocal dysfunction, or impaired speech;
``(F) female hirsutism, male-pattern baldness,
breast atrophy, breast development, or other secondary-
sex-characteristic changes caused by cross-sex
hormones;
``(G) osteoporosis, osteopenia, impaired bone
development, fractures, reduced bone density, or other
skeletal disorders associated with puberty suppression
or cross-sex hormone use;
``(H) cardiovascular disease, thromboembolic
disease, hypertension, stroke, myocardial infarction,
metabolic syndrome, diabetes, or other cardiovascular
or metabolic complications associated with such
procedures;
``(I) surgical complications, including infection,
fistula formation, stenosis, tissue necrosis, chronic
pain, nerve damage, graft failure, implant
complications, wound complications, or the need for
revision surgery;
``(J) loss, removal, alteration, or impairment of
healthy reproductive organs, breasts, genital
structures, or other healthy tissues;
``(K) reconstructive, regenerative, prosthetic,
plastic, or other surgical interventions intended to
restore healthy anatomy, appearance, or physiological
function;
``(L) rehabilitation services, including speech
therapy, physical therapy, occupational therapy, pelvic
floor therapy, sexual health counseling, and other
therapies intended to restore healthy functioning;
``(M) psychiatric or psychological conditions
associated with or exacerbated by such procedures,
including depression, anxiety, trauma, suicidality,
grief, regret, identity distress, body-image
disturbance, or dissociation;
``(N) diagnostic testing, specialist evaluations,
fertility assessments, hormone monitoring, cancer
screening, and long-term medical surveillance
necessitated by altered anatomy or prior exposure to
puberty blockers, cross-sex hormones, or sex-rejecting
surgeries;
``(O) fertility services that seek to cooperate
with, or restore the healthy physiology and anatomy of,
the human reproductive system, without the use of
methods that circumvent natural human functions, such
as any treatments or procedures that involve the
handling of a human egg or embryo outside the body;
``(P) breast cancer in men on estrogen and certain
cancers in women on testosterone; and
``(Q) any other physical, psychological,
reproductive, endocrine, neurologic, cardiovascular,
musculoskeletal, or metabolic injury, impairment,
complication, or condition resulting from or associated
with a sex-rejecting procedure.
``(5) Sex.--The term `sex', when referring to an
individual's sex, means to refer to either male or female, as
genetically determined at fertilization.
``(6) Sex-rejecting procedure.--
``(A) In general.--The term `sex-rejecting
procedure' means any medical or surgical intervention
for the purpose of attempting to align an individual's
physical appearance or body with an asserted identity
that differs from the individual's sex, including--
``(i) gonadotropin-releasing hormone (GnRH)
agonists or any other puberty-blocking or
suppressing drugs to stop or delay normal
puberty;
``(ii) testosterone, dihydrotestosterone
(DHT), or other androgens, estrogen,
progesterone, to an individual at doses that
are supraphysiologic to what would normally be
produced endogenously in a healthy individual
of the same age and sex, as well as anti-
androgen medications;
``(iii) castration;
``(iv) orchiectomy;
``(v) scrotoplasty;
``(vi) implantation of erection or
testicular prostheses;
``(vii) vasectomy;
``(viii) hysterectomy;
``(ix) oophorectomy;
``(x) ovariectomy;
``(xi) reconstruction of the fixed part of
the urethra with or without a metoidioplasty or
a phalloplasty;
``(xii) metoidioplasty;
``(xiii) penectomy;
``(xiv) phalloplasty;
``(xv) vaginoplasty;
``(xvi) clitoroplasty;
``(xvii) vaginectomy;
``(xviii) vulvoplasty;
``(xix) reduction thyrochondroplasty;
``(xx) chondrolaryngoplasty;
``(xxi) mastectomy;
``(xxii) tubal ligation;
``(xxiii) sterilization;
``(xxiv) any plastic, cosmetic, or
aesthetic surgery that feminizes or
masculinizes the facial or other physiological
features of an individual;
``(xxv) any placement of chest implants to
create feminine breasts;
``(xxvi) any placement of fat or artificial
implants in the gluteal region;
``(xxvii) augmentation mammoplasty;
``(xxviii) liposuction;
``(xxix) lipofilling;
``(xxx) voice surgery;
``(xxxi) hair reconstruction;
``(xxxii) pectoral implants; and
``(xxxiii) the removal of any otherwise
healthy or non-diseased body part or tissue.
``(B) Exceptions.--The term `sex-rejecting
procedure' does not include the following when
furnished by a health care professional with the
consent of such individual or, if applicable, such
individual's parents or legal guardian:
``(i) Services to individuals born with a
medically verifiable disorder of sex
development, including an individual with
external sex characteristics that are
irresolvably ambiguous, such as an individual
born with 46,XX chromosomes with virilization,
an individual born with 46,XY chromosomes with
undervirilization, or an individual born having
both ovarian and testicular tissue.
``(ii) Services provided when a physician
has otherwise diagnosed a disorder of sex
development in which the physician has
determined through genetic or biochemical
testing that the individual does not have
healthy sex chromosome structure, sex steroid
hormone production, or sex steroid hormone
action for a healthy individual of the same sex
and age.
``(iii) The treatment of any infection,
injury, disease, or disorder that has been
caused by or exacerbated by the performance of
sex-rejecting procedures, whether or not the
sex-rejecting procedure was performed in
accordance with State and Federal law and
whether or not funding for the procedure is
permissible under this section.
``(iv) Any procedure undertaken because the
individual suffers from a physical disorder,
physical injury, or physical illness (but not
claimed mental distress) that would, as
certified by a physician, place the individual
in imminent danger of death or impairment of
major bodily function, unless the procedure is
performed.
``(v) Puberty suppression or blocking
prescription drugs for the purpose of
normalizing puberty for a minor experiencing
precocious puberty.
``(vi) Male circumcision.''.
(2) Clerical amendment.--The table of sections for
subchapter B of chapter 100 of the Internal Revenue Code of
1986 is amended by adding at the end the following new item:
``Sec. 9827. Required coverage of items and services to address the
harms of sex-rejecting procedures.''.
(d) Effective Date.--The amendments made by this section shall
apply with respect to plan years beginning on or after January 1, 2027.
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