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EXPLANATION: CAPITALS INDICATE MATTER ADDED TO EXISTING LAW.
[Brackets] indicate matter deleted from existing law.
*hb1435*
HOUSE BILL 1435
J5 6lr3342
By: Delegates Spiegel, Bouchat, Crutchfield, Foley, Hornberger, Kaiser, Kaufman,
Miller, Rose, Tomlinson, and Woorman
Introduced and read first time: February 13, 2026
Assigned to: Health
A BILL ENTITLED
AN ACT concerning 1
Health Insurance – Required Coverage – Hormone–Related Care 2
FOR the purpose of requiring certain insurers, nonprofit health service plans, and health 3
maintenance organizations to provide certain coverage for hormone –related care , 4
including hormone therapy treatment for perimenopausal and menopausal 5
symptoms; establishing certain requirements and prohibitions related to coverage 6
for hormone–related care; and generally relating to health insurance coverage for 7
hormone–related care. 8
BY adding to 9
Article – Insurance 10
Section 15–864 11
Annotated Code of Maryland 12
(2017 Replacement Volume and 2025 Supplement) 13
Preamble 14
WHEREAS, Perimenopause and menopause are common, medically recognized 15
hormonal transitions experienced by a substantial portion of Maryland’s adult population; 16
and 17
WHEREAS, Individuals experiencing perimenopause or menopause frequently seek 18
hormone–related care to manage symptoms that, when untreated, can lead to avoidable 19
emergency visits, repeated diagnostic testing, and long–term health complications; and 20
WHEREAS, Insurance coverage f or clinically appropriate perimenopausal and 21
menopausal hormone therapy is inconsistent across carriers, resulting in delays, denials, 22
and unnecessary administrative barriers; and 23
2 HOUSE BILL 1435
WHEREAS, Ensuring timely access to medically necessary hormone–related care for 1
perimenopausal and menopausal individuals promotes health stability, reduces long–term 2
system costs, and supports the well–being of Maryland residents; and 3
WHEREAS, Establishing uniform statewide standards for hormone –related care is 4
necessary to reduce disparities in coverage, improve health outcomes, and ensure that 5
Marylanders experienci ng perimenopause or menopause receive consistent, 6
evidence–based treatment; now, therefore, 7
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 8
That the Laws of Maryland read as follows: 9
Article – Insurance 10
15–864. 11
(A) (1) IN THIS SECTION THE FOLLOWING WORDS HAVE THE MEANINGS 12
INDICATED. 13
(2) “HORMONE–RELATED CARE” MEANS MEDICALLY NECE SSARY 14
TREATMENT INVOLVING THE PRESCRIPTION, ADMINISTRATION, MONITORING, OR 15
ADJUSTMENT OF HORMON E THERAPIES FOR ENDO CRINE, REPRODUCTIVE, 16
METABOLIC, PERIMENOPAUSAL, MENOPAUSAL, OR OTHER CONDITIONS. 17
(3) “MEDICALLY NECESSARY” MEANS CARE THAT IS: 18
(I) CONSISTENT WITH GENE RALLY ACCEPTED STAND ARDS OF 19
MEDICAL PRACTICE; 20
(II) CLINICALLY APPROPRIATE FOR THE PATIENT’S CONDITION; 21
AND 22
(III) NOT PRIMARILY FOR THE CO NVENIENCE OF THE PAT IENT 23
OR PROVIDER. 24
(B) THIS SECTION APPLIES TO: 25
(1) INSURERS AND NONPROF IT HEALTH SERVICE PL ANS THAT 26
PROVIDE HOSPITAL, MEDICAL, OR SURGICAL BENEFITS TO INDIVIDUALS OR GROUPS 27
ON AN EXPENSE –INCURRED BASIS UNDER HEALTH INSURANCE POLICI ES OR 28
CONTRACTS THAT ARE ISSUED OR DELIVERED IN THE STATE; AND 29
HOUSE BILL 1435 3
(2) HEALTH MAINTENANCE O RGANIZATIONS THAT PR OVIDE 1
HOSPITAL, MEDICAL, OR SURGICAL BENEFITS TO INDIVIDUALS OR GROUPS UNDER 2
CONTRACTS THAT ARE ISSUED OR DELIVERED IN THE STATE. 3
(C) AN ENTITY SUBJECT TO THIS SECTION SHALL PROVIDE COVERAGE FOR 4
HORMONE–RELATED CARE, INCLUDING: 5
(1) HORMONE REPLACEMENT THERAPY; 6
(2) HORMONE SUPPRESSION OR MODULATION THERAPY; 7
(3) HORMONE–MODULATING MEDICATIONS; 8
(4) LABORATORY TESTING , DIAGNOSTIC EVALUATIO NS, AND 9
ONGOING MONITORING RELATED TO HORMONE THERAPY; AND 10
(5) CLINICAL VISITS FOR THE INITIATION AND C ONTINUATION OF 11
HORMONE THERAPY OR OTHER HORMONE–RELATED CARE. 12
(D) COVERAGE UNDER THIS SECTION MAY NOT BE DENIED BASED ON: 13
(1) THE SPECIFIC DIAGNOS IS FOR WHICH THE HOR MONE–RELATED 14
CARE IS PRESCRIBED , INCLUDING MENOPAUSAL AND PERIMENOPAUSAL 15
SYMPTOMS; 16
(2) THE PATIENT’S AGE; OR 17
(3) PRIOR USE OR NONUSE OF HORMONE–RELATED CARE. 18
(E) AN ENTITY SUBJECT TO THIS SECTION MAY NOT: 19
(1) IMPOSE EXCLUSIONS OR LIMITA TIONS ON HORMONE –RELATED 20
CARE THAT ARE MORE R ESTRICTIVE THAN THOSE APPLIED TO COM PARABLE 21
PRESCRIPTION DRUGS OR MEDICAL SERVICES; 22
(2) REQUIRE PRIOR AUTHORIZATION, STEP THERAPY, OR REPEATED 23
MEDICAL NECESSITY RE VIEWS THAT AR E MORE BURDENSOME TH AN THOSE 24
APPLIED TO COMPARABLE TREATMENTS; 25
(3) DENY COVERAGE SOLELY BECAUSE THE HORMONE –RELATED 26
CARE IS NEEDED AS AN ONGOING, LONG–TERM TREATMENT; OR 27
4 HOUSE BILL 1435
(4) APPLY HIGHER COST –SHARING, COPAYMENTS, OR DEDUCTIBLES 1
FOR HORMONE–RELATED CARE THAN COMPARABLE TREATMENTS. 2
(F) (1) A DETERMINATION OF MED ICAL NECESSITY FOR 3
HORMONE–RELATED CARE SHALL BE BASED ON: 4
(I) EVIDENCE–BASED CLINICAL GUIDELINES; 5
(II) THE PROFESSIONAL JUD GMENT OF THE TREATIN G 6
PROVIDER; AND 7
(III) THE INDIVIDUAL NEEDS OF THE PATIENT. 8
(2) AN ENTITY SUBJECT TO THIS SECTION MAY NOT SUBSTITUTE ITS 9
OWN CLINICAL JUDGMEN T FOR THAT OF THE TR EATING PROVIDER IF THE 10
PROVIDER’S DETERMINATION IS CON SISTENT WITH ACCEPTE D MEDICAL 11
STANDARDS. 12
(G) AN ENTITY SUBJECT TO THIS SECT ION SHALL ENSURE THA T COVERED 13
INDIVIDUALS HAVE TIMELY ACCESS TO HORMONE–RELATED CARE, INCLUDING: 14
(1) ACCESS TO IN –NETWORK PROVIDERS WI TH APPROPRIATE 15
EXPERTISE IN ENDOCRINE, REPRODUCTIVE, PERIMENOPAUSAL, AND MENOPAUSAL 16
CARE; AND 17
(2) COVERAGE FOR OUT–OF–NETWORK PROVIDERS IF IN–NETWORK 18
ACCESS IS UNAVAILABLE WITHIN A REASONABLE TRAVEL AREA. 19
(H) (1) ON OR BEFORE JANUARY 1 EACH YEAR, BEGINNING IN 2028, EACH 20
ENTITY SUBJECT TO THIS SECTION SHALL REPORT TO THE ADMINISTRATION ON: 21
(I) THE TOTAL NUMBER OF CLAIMS SUBMITTED FOR 22
HORMONE–RELATED CARE IN THE IMMEDIATELY PRECEDIN G YEAR, INCLUDING 23
CARE RELATED TO PERIMENOPAUSE AND MENOPAUSE; 24
(II) THE TOTAL NUMBER OF CLAIMS DENIED AND THE REASONS 25
FOR DENYING THE CLAIMS; AND 26
(III) THE AVERAGE AUTHORIZATION AND PROCESSING TIMES. 27
(2) ON OR BEFORE JULY 1 EACH YEAR , BEGINNING IN 2028, THE 28
ADMINISTRATION SHALL SUBMIT TO THE GENERAL ASSEMBLY, IN ACCORDANCE 29
HOUSE BILL 1435 5
WITH § 2–1257 OF THE STATE GOVERNMENT ARTICLE, A REPORT SUMMARIZING 1
THE INFORMATION SUBMITTED UNDER PARAGRAPH (1) OF THIS SUBSECTION. 2
(I) THE ADMINISTRATION SHALL ADOPT REGULATIONS TO CARRY OUT 3
THIS SECTION. 4
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall apply to all 5
policies, contracts, and health benefit plans issued, delivered, or renewed in the State on or 6
after January 1, 2027. 7
SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 8
January 1, 2027. 9