Bill H.55 aims to enhance health insurance coverage for gender-affirming health care services and fertility-related services in Vermont. It mandates that health insurance plans, including Vermont Medicaid, provide coverage for gender-affirming health care services deemed medically necessary by the individual's health care provider. The bill specifies that coverage must not impose barriers such as requiring a specific duration of hormone therapy or multiple provider approvals before accessing gender-affirming surgeries. Additionally, it introduces a requirement for annual reporting by the Department of Financial Regulation on compliance and utilization of these services.

Furthermore, the bill establishes new provisions for fertility-related services, requiring health insurance plans to cover fertility diagnostic care, intrauterine insemination, in vitro fertilization (IVF) procedures, and fertility preservation services. It prohibits health insurance plans from imposing greater financial burdens for fertility services compared to other health conditions and outlines specific exclusions for experimental procedures and nonmedical costs. The Agency of Human Services is tasked with seeking federal approval to amend Vermont's Medicaid state plan to include these fertility-related services, with implementation set for January 1, 2026, for health insurance plans and contingent upon federal approval for Medicaid coverage.

Statutes affected:
As Introduced: 8-4088m