SB 5075 Washington Senate · 2025-2026 Regular Session

Concerning cost sharing for prenatal and postnatal care.

SB 5075 prohibits most health plans from charging copays, deductibles, or other cost-sharing fees for specific prenatal and postnatal services starting in 2026. It covers in-network office visits, ultrasounds, vitamins, and follow-up care like cesarean recovery during the pregnancy period (from first pregnancy-related claim until delivery) and for 12 weeks after birth (up to one year for complications). Prescription drugs for pregnancy-related conditions are also exempt from cost-sharing starting in 2027. The bill applies to nongrandfathered health plans in Washington, directly affecting pregnant and postpartum individuals by eliminating out-of-pocket costs for these essential services.

Issues: ✓ Healthcare

Bill status in committee 1 of 4 stages cleared

Introduction

Jan 2026

Committee Review

Floor Vote

Governor

Introduced Jan 12, 2026 Last action Jan 12, 2026

Maddy AI version diff · 1 comparison

What changed between versions

Bill → Substitute Bill · 6 edits

MODERATE

The bill was amended to expand its scope from only new maternity care laws to also updating existing state insurance codes. It now explicitly applies to 'nongrandfathered' plans and clarifies that cost-sharing bans apply only to 'in-network' services. The timeline was split, with prenatal care coverage starting in 2026 and prescription drug coverage for pregnancy complications starting in 2027.

Scope change

The bill's scope expanded from a standalone new section to include amendments to existing state insurance statutes (RCW 41.05.017 and others), ensuring the new maternity rules apply to all relevant health plans, including those created by insuring entities.

ELIGIBILITY

Added the term 'nongrandfathered' to specify that the cost-sharing bans apply only to health plans that are not grandfathered under older regulations.

REQUIREMENT

Restricted the ban on cost-sharing to 'in-network' services only, rather than all services, for both prenatal and postnatal care.

TIMELINE

Split the implementation timeline: prenatal care cost-sharing bans begin January 1, 2026, while prescription drug cost-sharing bans begin January 1, 2027.

DEFINITION

Added a new subsection defining the specific start and end dates for the prenatal and postnatal service periods based on diagnosis codes and delivery dates.

ENFORCEMENT

Added a provision authorizing the Office of the Insurance Commissioner to adopt rules necessary to implement the new section.

SCOPE

Amended existing state insurance codes to explicitly list the new maternity care section and related chapters as applicable to various types of health plans.

Floor votes

How they voted

No floor votes recorded yet.

Full legislative history

Actions timeline

Total actions

Key actions

Committee

Jan 12, 2026

Introduced

By resolution, reintroduced and retained in present status.

upper

Feb 20, 2025

Upper · Passed

Public hearing in the Senate Committee on Ways & Means at 4:00 PM.

upper

Feb 14, 2025

Committee

Referred to Ways & Means.

upper

Feb 13, 2025

Committee

And refer to Ways & Means.

upper

Feb 13, 2025

Upper · Passed

Executive action taken in the Senate Committee on Health & Long-Term Care at 8:00 AM.

upper

Jan 21, 2025

Upper · Passed

Public hearing in the Senate Committee on Health & Long-Term Care at 10:30 AM.

upper

1 primary · 14 co-sponsors