NY State Senate Bill 2025-S5556

Senate Bill S5556

2025-2026 Legislative Session

Relates to prohibiting the exclusion of coverage based upon gender indication on insurance claim forms

download bill text pdf

Current Bill Status - In Senate Committee Insurance Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Feb 25, 2025	referred to insurance

co-Sponsors

2025-S5556 (ACTIVE) - Details

Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in Other Legislative Sessions:: 2019-2020: S5330
2021-2022: S726
2023-2024: S3234

2025-S5556 (ACTIVE) - Summary

Relates to gender indication on insurance claim forms; provides policies shall not exclude coverage if gender indication is different from sex assigned at birth or gender otherwise recorded.

2025-S5556 (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S5556

SPONSOR: HOYLMAN-SIGAL
 
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 individ-
uals 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:

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.

2025-S5556 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5556
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                             February 25, 2025
                                ___________
 
 Introduced by Sens. HOYLMAN-SIGAL, WEBB -- read twice and ordered print-
   ed, and when printed to be committed to the Committee on Insurance
 
 AN ACT to amend the insurance law, in relation to prohibiting the exclu-
   sion of coverage based upon gender indication on claim forms
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subsection (i) of section 3216  of  the  insurance  law  is
 amended by adding a new paragraph 41 to read as follows:
   (41)  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
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD07854-02-5
 S. 5556                             2

 
 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 (ww) to read as follows:
   (WW) 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 succeed-
 ing 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.

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Senate Bill S5556

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Sponsored By

Brad Hoylman-Sigal