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Bill

S 10465

Relates to prohibiting the exclusion of coverage based upon gender indication on insurance claim forms

2025 Regular Session Introduced by Erik Bottcher and 1 co-sponsor

Prohibits health insurance coverage exclusions solely due to gender indicated on a claim form or mismatches with the insured’s recorded gender.

REFERRED TO INSURANCE
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WeVote Research Nonpartisan
Bill Summary · S 10465

Overview

  • Bill: S 10465
  • Session: 2025-2026
  • Jurisdiction: New York
  • Title: Relates to prohibiting the exclusion of coverage based upon gender indication on insurance claim forms
  • Introduced by: Sens. Bottcher, Webb
  • Current status: Referred to the Senate Committee on Insurance (May 15, 2026)
  • principal sponsors: Lea Webb (co-sponsor), Erik Bottcher (co-sponsor)

Purpose and Intent

The bill aims to prohibit health insurance coverage exclusions that arise solely because of the gender indicated on an insurance claim form, or because that gender indication differs from the insured’s sex assigned at birth or recorded gender. In short, it seeks to ensure that coverage for hospital, surgical, or medical care is not withheld or limited simply due to gender markers on forms.

Key Provisions

  • Amendments to Insurance Law:
    • Section 3216(i): Adds a new paragraph (42) stating that policies providing hospital, surgical, or medical care may not exclude coverage for screening, diagnosis, or treatment of medical conditions (or services otherwise covered by the policy) solely on the basis of:
    • The gender indicated on a claim form, or
    • A gender indication that differs from the insured’s sex assigned at birth or gender otherwise recorded, or
    • The insured is not of the gender to whom a service is provided.
    • The provision permits insurers to take reasonable steps to verify eligibility, investigate potential fraud, or review clinical appropriateness, including requesting additional information.
    • Section 3221 (l), adding new paragraph (24) with identical language to ensure consistent protection across policy types.
    • Section 4303: Adds new subsection (yy) to the insurance contract statute, extending the same prohibition to contracts that provide hospital, surgical, or medical coverage, with the same caveats about verification, fraud review, and clinical appropriateness.
  • Effective Date:
    • The act takes effect on the first day of January after it becomes law.
    • Applies to policies and contracts issued, renewed, modified, altered, or amended on or after the effective date.

Affected Entities and Coverage

  • Affected Coverage: Policies and contracts that provide hospital, surgical, or medical care.
  • Protections Apply To: Screenings, diagnoses, and treatments for medical conditions that would otherwise be covered under the policy.
  • Notably Excluded: The bill does not bar reasonable insurer actions to verify eligibility, address potential fraud, or assess clinical appropriateness.

Procedural and Timeline Aspects

  • Introduction Date: May 15, 2026
  • Procedure: Referred to the Senate Insurance Committee for review.
  • Effective Date and Application:
    • The law would become effective on January 1 of the year following enactment.
    • It would apply to new or amended policies/contracts issued on or after that date.

Potential Impact and Implications

  • Access and Non-Discrimination: Aims to reduce barriers to care by removing gender-based exclusions tied solely to claim form gender indicators.
  • Administrative Consistency: Allows insurers to perform standard eligibility, fraud, and clinical appropriateness checks, ensuring that the protections do not impede necessary investigations.
  • Legal and Compliance: Aligns New York insurance practice with anti-discrimination goals related to gender identity, while preserving reasonable administrative controls.
  • Implementation Considerations: Insurers may need to review claim-processing systems to ensure gender-marker fields do not automatically trigger exclusions and to provide clear justifications when requesting additional information.

Summary

S 10465 would prohibit health insurance coverage exclusions based solely on the gender indicated on a claim form or discrepancies between that gender and the insured’s recorded gender, covering hospital, surgical, and medical services. It preserves insurer rights to verify eligibility and assess fraud or clinical appropriateness. The bill would take effect January 1 following enactment and apply to policies/contracts issued or renewed on or after that date.

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

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