Bill > HB1435

This bill requires certain insurance providers, including nonprofit health service plans and health maintenance organizations (HMOs), to cover "hormone-related care," which is defined as medically necessary treatment involving hormones for various conditions like perimenopause and menopause. This coverage must include hormone replacement therapy, hormone suppression or modulation therapy, related medications, necessary laboratory testing and monitoring, and clinical visits for initiating or continuing treatment. The bill prohibits denying coverage based on the specific diagnosis, the patient's age, or prior use of hormone therapy, and it prevents insurers from imposing more restrictive exclusions, limitations, prior authorization requirements, or higher cost-sharing than for comparable treatments. Determinations of medical necessity must be based on evidence-based guidelines, the treating provider's professional judgment, and the patient's individual needs, and insurers cannot substitute their own judgment if the provider's decision aligns with accepted medical standards. Furthermore, insurers must ensure timely access to in-network providers with expertise in relevant care and cover out-of-network providers if in-network access is unavailable. Starting in 2028, these entities must report data on hormone-related care claims, denials, and processing times to the Maryland Insurance Administration, which will then report to the General Assembly. The bill takes effect on January 1, 2027, and applies to policies and plans issued, delivered, or renewed on or after that date.

Health and Social Services

https://mgaleg.maryland.gov/mgawebsite/Legislation/Details/HB1435?ys=2026RS