RI 2026 H8587: Insurance - Accident and Sickness Insurance Policies

Plain-English Summary

This bill requires all individual and group health insurance plans in Rhode Island to cover medically necessary hormone and non-hormone therapies for treating peri-menopause and menopause symptoms. The coverage must include at least one FDA-approved treatment of each type (hormonal and non-hormonal). Additionally, the insurance plans must cover at least one hormone replacement therapy option in various forms, including oral pills, skin patches (transdermal), topical creams, and vaginal applications. This requirement applies to insurance policies issued or renewed on or after January 1, 2027.

For younger readers

When women get older, their bodies go through natural changes called menopause, which can sometimes make them feel sick or uncomfortable. Doctors can give them special medicine called hormone therapy to help them feel better. This new rule says that starting in 2027, health insurance companies—the businesses that help pay for medical bills—must pay for these medicines. The rule makes sure that different types of this medicine, like pills or skin creams, are covered so women can get the exact help they need.

Who & Where It Applies

Impacted groups

Women experiencing menopause or peri-menopauseHealth insurance companiesHealthcare providersEmployers providing health benefitsPharmacists

Impacted communities

All

Constitutional & Fiscal Check

None Likely

Estimated cost

Amount unknown

Estimated revenue

None

Bill Analysis

Both viewpoints

For Progressives

Promotes gender equity in healthcare by ensuring women have guaranteed access to necessary treatments for menopause and peri-menopause symptoms.
Reduces out-of-pocket medical expenses, providing financial relief and ensuring that economically disadvantaged individuals can afford essential reproductive aging care.
Prevents corporate health insurers from limiting care by explicitly mandating coverage for multiple treatment modalities, empowering patients and doctors over corporate interests.
Delays the implementation of the coverage mandate until 2027, leaving individuals to face out-of-pocket costs for several more years.
Only requires coverage for "at least one" treatment option per category, which could allow insurers to restrict access to specific medications a patient might prefer or need.
Does not eliminate copays or deductibles for these treatments, meaning low-income patients may still face significant financial barriers to accessing care.

For Conservatives

Provides insurance companies with a long lead time (until 2027) to adjust their financial models and pricing structures to accommodate the new requirements.
Limits the mandate strictly to "medically necessary" and FDA-approved treatments, preventing coverage for unproven or experimental procedures.
Supports the health and well-being of older women and mothers, aligning with traditional family values by ensuring they can comfortably manage age-related health changes.
Infringes on free-market principles by dictating the specific services and treatment modalities that private insurance companies must offer.
Will likely increase the overall cost of health insurance premiums for all subscribers, as companies pass the cost of this new mandate onto consumers.
Represents unnecessary government overreach into private contracts, further burdening businesses with heavy-handed regulatory micromanagement.

Votes

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Full Bill Text

Changes to existing Rhode Island law · 40 additions

SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance Policies" is hereby amended by adding thereto the following section: 27-18-96. Coverage for hormonal and non-hormonal therapy to treat the symptoms of peri-menopause and menopause.

(a) Every individual or group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state on or after January 1, 2027, shall provide coverage for medically necessary hormone therapy treatment to treat the symptoms of peri-menopause and menopause.

(b) Coverage for hormone replacement therapy to treat the symptoms of peri-menopause and menopause under this section shall mean at least one federal Food and Drug Administration- approved hormonal and non-hormonal treatment, and at least one hormonal replacement therapy option in each of the following modalities: oral, transdermal, topical, and vaginal.

SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service Corporations" is hereby amended by adding thereto the following section: 27-19-88. Coverage for hormonal and non-hormonal therapy to treat the symptoms of peri-menopause and menopause.

(a) Every individual or group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state on or after January 1, 2027, shall provide coverage for medically necessary hormone therapy treatment to treat the symptoms of peri-menopause and menopause.

(b) Coverage for hormone replacement therapy to treat the symptoms of peri-menopause and menopause under this section shall mean at least one federal Food and Drug Administration- approved hormonal and non-hormonal treatment, and at least one hormonal replacement therapy option in each of the following modalities: oral, transdermal, topical, and vaginal.

SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service Corporations" is hereby amended by adding thereto the following section: 27-20-84. Coverage for hormonal and non-hormonal therapy to treat the symptoms of peri-menopause and menopause.

(a) Every individual or group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state on or after January 1, 2027, shall provide coverage for medically necessary hormone therapy treatment to treat the symptoms of peri-menopause and menopause.

(b) Coverage for hormone replacement therapy to treat the symptoms of peri-menopause and menopause under this section shall mean at least one federal Food and Drug Administration- approved hormonal and non-hormonal treatment, and at least one hormonal replacement therapy option in each of the following modalities: oral, transdermal, topical, and vaginal.

SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance Organizations" is hereby amended by adding thereto the following section: 27-41-101. Coverage for hormonal and non-hormonal therapy to treat the symptoms of peri-menopause and menopause.

(a) Every individual or group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state on or after January 1, 2027, shall provide coverage for medically necessary hormone therapy treatment to treat the symptoms of peri-menopause and menopause.

(b) Every individual or group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state on or after January 1, 2027, shall provide coverage for medically necessary hormone therapy treatment to treat the symptoms of peri-menopause and menopause.

SECTION 5. This act shall take effect upon passage.