WeVote
Log In

Bill

Bill

HD 428

An Act relative to insurance coverage for certain surgeries

194th Legislature (2025-2026) Introduced by Marc Lombardo

HD 428: An Act relative to insurance coverage for certain surgeries OverviewBill Number: HD 428 Title: An Act relative to insurance coverage for certain surgeriesStatus: Proposed

0
WeVote Research Nonpartisan
Bill Summary · HD 428

HD 428: An Act relative to insurance coverage for certain surgeries

Overview

Bill Number: HD 428
Title: An Act relative to insurance coverage for certain surgeries
Status: Proposed bill
Introduced: November 29, 2025

Purpose and Intent

The primary goal of this bill is to expand insurance coverage for gender-affirming surgical procedures for transgender and non-binary individuals. The legislation aims to address disparities in access to medically necessary care and ensure that individuals can receive the treatments recommended by their healthcare providers without facing prohibitive out-of-pocket costs.

Key Provisions

  • Requires all private insurance plans operating in the state to cover a range of gender-affirming surgical procedures, including:
    • Top surgery (breast/chest reconstruction)
    • Bottom surgery (genital reconstruction)
    • Facial feminization/masculinization surgery
    • Voice surgery
  • Prohibits insurance plans from imposing any annual or lifetime dollar limits, deductibles, copays, or other cost-sharing requirements that are more restrictive than those applied to other medical services.
  • Mandates that coverage decisions be made based on medical necessity as determined by the individual's treating provider, rather than arbitrary criteria.
  • Establishes an appeals process for individuals whose claims are denied, allowing them to challenge the insurer's decision.

Affected Parties and Impacts

This bill would directly benefit transgender and non-binary individuals in the state by improving their access to medically necessary, gender-affirming surgical procedures. It would reduce financial barriers that have historically prevented many from obtaining treatments recommended by their healthcare providers.

The legislation would also impact private insurance companies operating in the state, requiring them to adjust their coverage policies and benefit structures to comply with the new requirements. This could lead to increased costs that may be passed on to consumers through higher premiums.

Procedural and Timeline Considerations

HD 428 was introduced in the state legislature on November 29, 2025 and has been referred to the Joint Committee on Insurance. The committee will hold public hearings and deliberations before deciding whether to advance the bill for a full vote in the House and Senate. If passed by the legislature, the bill would then go to the governor for signature or veto.

Assuming the bill progresses through the legislative process, the new insurance coverage requirements would likely take effect at the start of the next plan year, providing individuals with access to the expanded benefits within 12-18 months of the bill's enactment.

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

Sign in to ask a question.