TRUTH in Coverage Act of 2026
Sponsored By: Senator Marshall, Roger [R-KS]
Introduced
Summary
Requires health plans to cover a wide set of restorative services after certain listed “sex-rejecting procedures.” The bill would add matching coverage duties to the Public Health Service Act, the Employee Retirement Income Security Act, and the tax code so plans that pay for any listed procedure must also cover enumerated services to address harms from those procedures with parity in cost and treatment limits.
Show full summary
- People who receive a listed sex-rejecting procedure would be entitled to coverage for a broad, enumerated set of "restorative care" services. Examples include reproductive and fertility services, reconstruction and prosthetics, hormone monitoring and related endocrine care, treatment of surgical complications, rehabilitation, and related mental-health services.
- Group health plans and health insurance issuers regulated under PHSA and ERISA would have to apply no stricter financial requirements or treatment limits to restorative-care items than to most other medical and surgical benefits. Plans could not impose separate deductibles, separate copays, tiering, or other separate cost-sharing only for restorative care and the bill explicitly treats aggregate annual and lifetime limits as financial requirements.
- The bill defines key terms. It defines "male" and "female" by biological sex and lists many specific covered "sex-rejecting procedures" such as puberty blockers, hormone therapy, castration, hysterectomy, mastectomy, phalloplasty, and others while carving out exceptions like treatment for disorders of sex development, emergency care, and puberty suppression for precocious puberty. The coverage rules would apply to plan years beginning on or after January 1, 2027.
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Bill Overview
Analyzed Economic Effects
2 provisions identified: 1 benefits, 0 costs, 1 mixed.
Restorative care coverage after procedures
If your group health plan covers any listed sex‑rejecting procedure, it would also have to cover restorative care for harms from that procedure. Restorative care would include reproductive, hormone, sexual, urinary, voice, bone, heart, surgical-complication, reconstructive, prosthetic, rehabilitation, mental health, long-term monitoring, diagnostic testing, and certain fertility services that restore natural function. Plans and issuers would not be allowed to apply higher cost-sharing, separate deductibles or copays, separate tiers, or stricter annual or lifetime limits to restorative care than the plan’s main medical and surgical benefits. These coverage rules would apply to plan years beginning on or after January 1, 2027.
Which procedures trigger restorative coverage
The bill would define 'sex‑rejecting procedure' with a long list of drugs, surgeries, implants, removals, and cosmetic interventions meant to align a body with an asserted gender identity. It would also list exceptions, such as care for certain disorders of sex development, results from diagnostic testing, emergency or imminent danger care, treatment for precocious puberty, and male circumcision. The bill would define 'female', 'male', and 'sex' as biological categories tied to gamete production and genetics for applying these coverage rules. These definitions would apply to plan years beginning on or after January 1, 2027.
Sponsors & CoSponsors
Sponsor
Marshall, Roger [R-KS]
KS • R
Cosponsors
Sen. Lummis, Cynthia M. [R-WY]
WY • R
Sponsored 7/16/2026
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov