A new state law will require all health plans to cover pelvic-floor physical therapy—and small businesses that sponsor employee plans should understand the cost impact.
Most New Hampshire health services owners and employers don't realize that a provision buried in HB1656 will reshape what their employee health plans must cover—and what they'll pay for it.
Here's what's happening: Effective July 1, 2027, all health insurance plans in New Hampshire must cover pelvic-floor physical therapy (PFPT) without categorical exclusion. That means insurers can no longer simply refuse to pay for it across the board.
Under Section 2 of the bill (RSA 420-R:2(I), page 4), health plans must cover pelvic-floor physical therapy for a broad range of diagnoses and conditions. The coverage includes:
• Up to 12 or more weeks of therapy sessions
• Prehabilitation (therapy before surgery)
• Post-surgical rehabilitation
• Telehealth delivery
• Extensions beyond initial session limits when medically necessary
The key word is "without categorical exclusion." Insurers cannot simply exclude PFPT as a category. They must evaluate coverage on a clinical basis for eligible diagnoses.
The primary impact falls on small and mid-sized New Hampshire businesses that sponsor fully-insured group health plans for employees. When insurers must cover a new service broadly, they typically pass the cost to employers through higher premiums.
Self-insured employers (those who bear the risk themselves) may also see claims increase, depending on their plan design and employee population.
Health service providers—physical therapy clinics, hospitals, and rehabilitation centers—should expect increased demand for PFPT services once the law takes effect, but should also prepare for the administrative work of verifying coverage and managing prior authorizations under the new rules.
The effective date is July 1, 2027. That gives employers and insurers roughly two years to prepare. However, businesses renewing plans before that date will not be subject to this requirement until their next renewal on or after July 1, 2027.
Employers should begin conversations with their insurance brokers and carriers now to understand how this will affect their renewal rates and plan design options.
If you sponsor an employee health plan, ask your broker or carrier for a preliminary impact assessment. Request clarity on which diagnoses and conditions will be covered, what prior authorization or referral requirements will apply, and how this will affect your premium.
If you operate a health service—especially physical therapy or women's health—begin documenting your PFPT protocols and outcomes now. Insurers will likely develop clinical guidelines and utilization management processes before July 2027, and providers who can demonstrate evidence-based practice will navigate those processes more smoothly.
The law is real, the deadline is fixed, and the cost implications are material. Planning ahead is worth the effort.
For a more detailed, business-specific summary of HB1656 and its implications for your operation, resources are available through the New Hampshire Hospital Association and the state's insurance commissioner office.