What's happening
This bill bans health insurance from denying coverage based on gender listed on claim forms.
Why it matters
Expands protections statewide. This bill applies to all health insurance policies and contracts regulated under New York law, meaning its protections would extend to insured individuals across the entire state—including both individual and group plans.
Directly impacts transgender, nonbinary, and gender nonconforming New Yorkers. By prohibiting denial of coverage based on discrepancies between gender listed on a claim form and an individual’s sex assigned at birth (or other recorded gender), the bill addresses a key barrier faced by people whose gender identity differs from older medical records or insurance documents.
Eliminates a loophole for coverage denials while allowing fraud and appropriateness checks. The bill closes a common insurance loophole used to deny medically necessary care, such as cancer screenings or reproductive health services, when gender markers don’t “match.” However, insurers may still take steps to ensure claims are legitimate and medically appropriate, balancing nondiscrimination with fraud prevention.
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Who cares
Transgender and Non-binary Individuals
This group is directly affected, as the bill aims to prevent insurance companies from denying coverage for medical services based on discrepancies between gender markers on claim forms and the insured’s sex assigned at birth or other recorded gender.
Healthcare Providers
Physicians, clinics, and hospitals will care because the legislation reduces administrative barriers and denials of coverage for their patients, streamlining access to necessary screening, diagnosis, and treatment regardless of gender marker.
Insurance Companies
Insurers are key stakeholders, as the bill changes claims processing requirements and may increase the number of claims they must review for gender-related discrepancies, while still allowing for fraud prevention and clinical appropriateness checks.
LGBTQ+ Advocacy Organizations
These organizations will care deeply about the bill, as it aligns with efforts to eliminate discrimination in healthcare access and insurance coverage for LGBTQ+ people, especially those whose gender identity may not match traditional documentation.
Headline styles
Ban Gender-Based Insurance Denials
Plain English, a few words. Used as the page title.
Sponsors
1 Co-sponsor
History
- Referred to insurance
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
10465
IN SENATE
May 15, 2026
Introduced by Sens. BOTTCHER, WEBB -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance
AN ACT to amend the insurance law, in relation to prohibiting the exclusion of coverage based upon gender indication on claim forms
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Subsection (i) of section 3216 of the insurance law is amended by adding a new paragraph 42 to read as follows:
(42) Every policy that provides coverage for hospital, surgical or medical care shall not exclude coverage for screening, diagnosis and treatment of medical conditions, or services otherwise covered by the policy solely on the basis of the gender indicated on a claim form, or that the gender indicated on a claim form is different from the insured's sex assigned at birth or gender otherwise recorded, or that the insured is not of the gender to whom a service is provided. Nothing herein shall limit the insurer's ability to take reasonable steps, including requesting additional information, to determine whether the insured is eligible for the services, to review the claim for potential fraud, or to review the claim for clinical appropriateness.
§ 2. Subsection (l) of section 3221 of the insurance law is amended by adding a new paragraph 24 to read as follows:
(24) Every policy that provides coverage for hospital, surgical or medical care shall not exclude coverage for screening, diagnosis and treatment of medical conditions, or services otherwise covered by the policy solely on the basis of the gender indicated on a claim form, or that the gender indicated on a claim form is different from the insured's sex assigned at birth or gender otherwise recorded, or that the insured is not of the gender to whom a service is provided. Nothing herein shall limit the insurer's ability to take reasonable steps, including requesting additional information, to determine whether the insured is eligible for the services, to review the claim for potential fraud, or to review the claim for clinical appropriateness.
§ 3. Section 4303 of the insurance law is amended by adding a new subsection (yy) to read as follows:
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD07854-03-6
(yy) Every contract that provides coverage for hospital, surgical or medical care shall not exclude coverage for screening, diagnosis and treatment of medical conditions, or services otherwise covered by the contract solely on the basis of the gender indicated on a claim form, or that the gender indicated on a claim form is different from the insured's sex assigned at birth or gender otherwise recorded, or that the insured is not of the gender to whom a service is provided. Nothing herein shall limit the insurer's ability to take reasonable steps, including requesting additional information, to determine whether the insured is eligible for the services, to review the claim for potential fraud, or to review the claim for clinical appropriateness.
§ 4. This act shall take effect on the first of January next succeeding the date on which it shall have become a law and shall apply to policies and contracts issued, renewed, modified, altered or amended on or after such effective date.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act to amend the insurance law, in relation to prohibiting the exclu- sion of coverage based upon gender indication on claim forms
Purpose
The purpose of this bill is to prohibit health insurance claim denials based on the gender of an insured person
Summary of specific provisions
Section 1 amends subdivision (1) of section 3216 of the insurance law to prohibit individual accident and health insurers from excluding coverage for screening, diagnosis and treatment of medical conditions, or services otherwise covered by the policy solely on the basis of the gender indicated on a claim form, or that the gender indicated on a claim form is different from the insured's sex assigned at birth or gender otherwise recorded, or that the insured is not of the gender to whom a service is typically or exclusively provided.
Section 2 amends subsection (1) of section 3221 of the insurance law to prohibit group insurers from excluding coverage for screening, diagnosis and treatment of medical conditions, or services otherwise covered by the policy solely on the basis of the gender indicated on a claim form, or that the gender indicated on a claim form is different from the insured's sex assigned at birth or gender otherwise recorded, or that the insured is not of the gender to whom a service is typically or exclusively provided.
Section 3 adds a new subsection (ss) to section 4303 of the insurance law to prohibit group insurers from excluding coverage for screening, diagnosis and treatment of medical conditions, or services otherwise covered by the policy solely on the basis of the gender indicated on a claim form, or that the gender indicated on a claim form is different from the insured's sex assigned at birth or gender otherwise recorded, or that the insured is not of the gender to whom a service is typically or exclusively provided.
Section 4 establishes the effective date.
Justification
It has come to light that health insurers have been denying claims of transgender individuals because the gender with which the individual identifies does not match the gender of someone to whom those services are typically provided. Additionally, claims of transgender individuals are being denied solely on the basis that the gender on a claim form does not match the gender on the insurance company's records. This results in individuals having to appeal these denials, many of which are subsequently overturned, before they can receive coverage. This bill addresses these issues and ensures that transgender individuals receive health care coverage in a timely manner by prohibiting health insurers from denying coverage solely on the basis of the gender indicated on a claim form, or that the gender on a claim form does not match the insured's gender otherwise recorded, or that the gender with which the individual identifies does not match the gender of someone to whom those services are typically provided.
Legislative history
S5556 of 2025: introduced by then-Senator Hoylman-Sigal
S.3234 of 2023-2024 (Hoylman-Sigal): Passed Senate
S.0726 of 2021-2022 (Hoylman): Died in Insurance
A.1327 of 2021-2022 (Woerner): Died in Insurance
S.5330 of 2019-2020 (Hoylman): Died in Insurance
A.6837 of 2019-2020 (Woerner): Died in Insurance
Fiscal implications
None
Effective date
This act shall take effect on the first of January next succeeding the date on which it shall have become law and shall apply to policies and contracts issued, renewed, modified, altered or amended on and after such date.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.