Exclusion of gender transition procedures from coverage under qualified health plans

(a) In general Section 1301(a)(1) of the Patient Protection and Affordable Care Act (42 U.S.C. 18021(a)(1)) is amended— (1) in subparagraph (B), by striking and after the semicolon; (2) in subparagraph (C)(iv), by striking the period at the end and inserting; and; and (3) by adding at the end the following: (D) does not provide coverage for gender transition procedures.. (b) Definition of gender transition procedure Section 1301 of the Patient Protection and Affordable Care Act (42 U.S.C. 18021) is amended by adding at the end the following: (c) Definitions relating to gender transition procedures (1) Gender transition procedure (A) In general For purposes of subsection (a)(1)(D), the term gender transition procedure means any hormonal or surgical intervention for the purpose of gender transition, including— (i) gonadotropin-releasing hormone (GnRH) agonists or other puberty-blocking or suppressing drugs to stop or delay normal puberty; (ii) testosterone, estrogen, progesterone, or other androgens 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; (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) Exclusions For purposes of subsection (a)(1)(D), the term gender transition procedure does not include the following when furnished to an individual by a health care provider 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 sexual development in which the physician has determined through genetic or biochemical testing that the individual does not have normal 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 gender transition procedures, whether or not the gender transition procedure was performed in accordance with State and Federal law or whether or not funding for the gender transition 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 mental, behavioral, or emotional distress or a mental, behavioral, or emotional disorder) 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) Related terms For purposes of paragraph (1): (A) Female The term female, when used to refer to a natural person, means an individual who naturally has, had, will have, or would have, but for a congenital anomaly, historical accident, or intentional or unintentional disruption, the reproductive system that at some point produces, transports, and utilizes eggs for fertilization. (B) Gender transition The term gender transition means the process in which an individual goes from identifying with or presenting as his or her sex to identifying with or presenting a self-proclaimed identity that does not correspond with or is different from his or her sex, and may be accompanied with social, legal, or physical changes. (C) Male The term male, when used to refer to a natural person, means an individual who naturally has, had, will have, or would have, but for a congenital anomaly, historical accident, or intentional or unintentional disruption, the reproductive system that at some point produces, transports, and utilizes sperm for fertilization. (D) Sex The term sex, when referring to an individual’s sex, means to refer to either male or female, as biologically determined.. (c) Effective date The amendments made by this section shall apply with respect to plan years beginning on or after January 1, 2026.