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Bill

Bill

S 5030

TRUTH in Coverage Act of 2026

119th Congress Introduced by Cynthia Lummis and 1 co-sponsor

The bill requires health plans covering sex-rejecting procedures to also cover restorative or harm-mitigation services to restore health and functioning.

Introduced in Senate
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WeVote Research Nonpartisan
Bill Summary · S 5030

Summary of Bill: S. 5030 (119th Congress)

Purpose and Intent

  • The bill amends multiple federal statutes to require group health plans and health insurance issuers that provide benefits for sex-rejecting procedures to also cover items and services intended to address harms caused by sex-rejecting procedures and to help restore healthy human form and functioning, to the greatest extent possible.
  • In broad terms, it aims to reverse or mitigate potential harms associated with gender-affirming or sex-rejecting medical procedures by expanding coverage to restorative or reparative services.

Key Provisions and Changes

  • Applicable Laws Targeted for Amendment

    • Title XXVII of the Public Health Service Act (PHSA)
    • The Employee Retirement Income Security Act of 1974 (ERISA)
    • The Internal Revenue Code of 1986

  • Coverage Requirements

    • Group health plans and health insurance issuers offering both group and individual coverage that currently provide benefits for sex-rejecting procedures must also provide benefits for:
    • Items and services addressing harms caused by sex-rejecting procedures
    • Services and items intended to restore healthy human form and functioning
    • The bill seeks parity in coverage between procedures that align with sex-rejection terminology and restorative measures, to the greatest extent feasible under the amended statutes.

  • Scope of Benefits

    • While the bill text as provided emphasizes restorative and harm-addressing services, it does not enumerate an explicit schedule of covered items in the summary. The expectation is that plans would need to include, at a minimum, services that directly address harms or dysphoria resulting from sex-rejecting procedures and support restoration where possible.

  • Non-Discrimination and Plan Operation

    • Applies to group health plans and health insurance issuers offering coverage that includes sex-rejecting procedures, ensuring that the restorative benefits are available alongside existing procedures.

Who Would Be Affected

  • Individuals with Employer-sponsored or Group Health Coverage

    • Those enrolled in plans that currently cover sex-rejecting procedures would gain access to additional restorative and harm-mitigation services under the same plans.

  • Health Plans and Insurers

    • Sponsors of group health plans and issuers of group or individual health insurance would be required to adjust benefit design and potentially expand networks and coverage for restorative services.

  • Employers and Plan Sponsors

    • Employers sponsoring or administering group health plans would bear responsibility to ensure compliance with the amended requirements.

Procedural and Timeline Aspects

  • Introduced and Referral

    • Introduced in the Senate and referred on 2026-07-16 to the Committee on Health, Education, Labor, and Pensions (HELP).

  • Sponsors

    • Co-sponsors include Senator Roger Marshall and Senator Cynthia Lummis.

  • Process Outlook

    • As a bill introduced in the Senate, progress would involve committee consideration, potential markups, and votes in the Senate. If advanced, it would need to pass the Senate and be reconciled with any House counterpart (if introduced) and then be signed by the President to become law.

Notes and Context

  • The bill centers on expanding coverage to restorative services related to sex-rejecting procedures, positioning them as parity-protected benefits alongside existing sex-rejecting procedure coverage.
  • Specific definitions, coverage limits, cost-sharing, and exclusions would be defined in the enacted text or subsequent regulatory guidance, which are not detailed in the summary provided.

If you’d like, I can extract or recreate a concise one-page briefing with a focus on potential cost, implementation challenges for plans, and practical examples of restorative services that might fall under the new requirements.

Compiled from official sources — confirm details with the bill’s official record.

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