The proposed bill requires various health insurance plans, including those from hospital service corporations, medical service corporations, and health maintenance organizations, to provide coverage for the treatment of lipedema. This coverage encompasses expenses for compression garments, manual lymphatic drainage, medical nutrition therapy, mental health care, and medically necessary lipectomy procedures, along with pre-and post-operative appointments. To be eligible for this coverage, individuals must submit documentation from their physician confirming a diagnosis of lipedema, and if applicable, additional documentation from their surgeon, which includes photographs and the number of lipectomies deemed necessary.

Additionally, the bill prohibits insurers from denying coverage based solely on submitted photographs and mandates that they provide a detailed explanation for any claim denials related to lipedema treatment. It also establishes that prior authorizations for lipectomy procedures are valid for one year, provided certain conditions are met, and that insurers must honor prior authorizations granted by previous carriers. The benefits outlined in the bill must adhere to the current standard of care for lipedema and be subject to the same deductibles and cost-sharing as similar services under the respective insurance contracts.