State and Federal law or whether or not 
funding for the gender transition proce-
dure is permissible under this section. 
‘‘(iv) Any procedure undertaken be-
cause the individual suffers from a physical 
disorder, physical injury, or physical illness 
(but not claimed mental distress) that 
would, as certified by a physician, place 
the individual in imminent danger of death 
or impairment of major bodily function, 
unless the procedure is performed. 
‘‘(v) Puberty suppression or blocking 
prescription drugs for the purpose of nor-
malizing puberty for a minor experiencing 
precocious puberty. 
‘‘(vi) Male circumcision. 
‘‘(4) MALE.—The term ‘male’, when used to 
refer to a natural person, means an individual who 
naturally has, had, will have, or would have, but for 
a congenital anomaly, historical accident, or inten-
tional or unintentional disruption, the reproductive 
system that at some point produces, transports, and 
utilizes sperm for fertilization. 
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‘‘(5) SEX.—The term ‘sex’, when referring to 
an individual’s sex, means to refer to either male or 
female, as biologically determined.’’. 
SEC. 102. AMENDMENT TO TABLE OF CHAPTERS. 
The table of chapters for title 1, United States Code, 
is amended by adding at the end the following new item: 
‘‘4. Prohibiting taxpayer-funded gender transition pro-
cedures .......................................................................
301’’. 
TITLE II—APPLICATION UNDER 
THE AFFORDABLE CARE ACT 
SEC. 201. CLARIFYING APPLICATION OF PROHIBITION TO 
PREMIUM CREDITS AND COST-SHARING RE-
DUCTIONS UNDER ACA. 
(a) IN GENERAL.— 
(1) DISALLOWANCE OF REFUNDABLE CREDIT 
AND
COST-SHARING
REDUCTIONS
FOR
COVERAGE 
UNDER QUALIFIED HEALTH PLAN WHICH PROVIDES 
COVERAGE FOR GENDER PROCEDURES.— 
(A) IN
GENERAL.—Subparagraph (A) of 
section 36B(c)(3) of the Internal Revenue Code 
of 1986 is amended by inserting before the pe-
riod at the end the following: ‘‘or any health 
plan that includes coverage for gender transi-
tion procedures, as defined in section 307 of 
title 1, United States Code (other than any pro-
cedure described in section 306 of such title)’’. 
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(B) OPTION TO PURCHASE OR OFFER SEP-
ARATE COVERAGE OR PLAN.—Paragraph (3) of 
section 36B(c) of such Code is amended by 
adding at the end the following new subpara-
graph: 
‘‘(C) SEPARATE COVERAGE OR PLAN FOR 
GENDER
TRANSITION
PROCEDURES
AL-
LOWED.— 
‘‘(i) OPTION TO PURCHASE SEPARATE 
COVERAGE OR PLAN.—Nothing in subpara-
graph (A) shall be construed as prohibiting 
any individual from purchasing separate 
coverage for gender transition procedures 
described in such subparagraph, or a 
health plan that includes such gender tran-
sition procedures, so long as no credit is 
allowed under this section with respect to 
the premiums for such coverage or plan. 
‘‘(ii) OPTION TO OFFER COVERAGE OR 
PLAN.—Nothing in subparagraph (A) shall 
restrict any non-Federal health insurance 
issuer offering a health plan from offering 
separate coverage for gender transition 
procedures described in such subpara-
graph, or a plan that includes such gender 
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transition procedures, so long as premiums 
for such separate coverage or plan are not 
paid for with any amount attributable to 
the credit allowed under this section (or 
the amount of any advance payment of the 
credit under section 1412 of the Patient 
Protection and Affordable Care Act).’’. 
(2) DISALLOWANCE
OF
SMALL
EMPLOYER 
HEALTH
INSURANCE
EXPENSE
CREDIT
FOR
PLAN 
WHICH INCLUDES COVERAGE FOR GENDER TRANSI-
TION PROCEDURES.—Subsection (h) of section 45R 
of the Internal Revenue Code of 1986 is amended— 
(A) by striking ‘‘Any term’’ and inserting 
the following: 
‘‘(1) IN GENERAL.—Any term’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(2) EXCLUSION OF HEALTH PLANS INCLUDING 
COVERAGE
FOR
GENDER
TRANSITION
PROCE-
DURES.— 
‘‘(A) IN
GENERAL.—In this section, the 
term ‘qualified health plan’ does not include 
any health plan that includes coverage for gen-
der transition procedures, as defined in section 
307 of title 1, United States Code (other than 
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any procedure described in section 306 of such 
title). 
‘‘(B) SEPARATE COVERAGE OR PLAN FOR 
GENDER
TRANSITION
PROCEDURES
AL-
LOWED.— 
‘‘(i) OPTION TO PURCHASE SEPARATE 
COVERAGE OR PLAN.—Nothing in subpara-
graph (A) shall be construed as prohibiting 
any employer from purchasing for its em-
ployees separate coverage for gender tran-
sition procedures described in such sub-
paragraph, or a health plan that includes 
such gender transition procedures, so long 
as no credit is allowed under this section 
with respect to the employer contributions 
for such coverage or plan. 
‘‘(ii) OPTION TO OFFER COVERAGE OR 
PLAN.—Nothing in subparagraph (A) shall 
restrict any non-Federal health insurance 
issuer offering a health plan from offering 
separate coverage for gender transition 
procedures described in such subpara-
graph, or a plan that includes such gender 
transition procedures, so long as such sep-
arate coverage or plan is not paid for with 
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any employer contribution eligible for the 
credit allowed under this section.’’. 
(b) APPLICATION TO MULTI-STATE PLANS.—Section 
1334(a) of Public Law 111–148 (42 U.S.C. 18054(a)) is 
amended by adding at the end the following new para-
graph: 
‘‘(8) COVERAGE
CONSISTENT
WITH
FEDERAL 
POLICY
REGARDING
GENDER
TRANSITION
PROCE-
DURES.—In entering into contracts under this sub-
section, the Director shall ensure that no multi-State 
qualified health plan offered in an Exchange pro-
vides health benefits coverage for which the expendi-
ture of Federal funds is prohibited under chapter 4 
of title 1, United States Code.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to taxable years ending after 
the date that is 1 year after the date of enactment of this 
Act, but only with respect to plan years beginning after 
such date, and the amendment made by subsection (b) 
shall apply to plan years beginning after such date. 
Æ 
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