; and (B) by adding at the end the following new paragraph: (2) Exclusion of health plans including coverage for gender-affirming care (A) In general The term qualified health plan does not include any health plan that includes coverage for gender-affirming care (other than any gender-affirming care or treatment described in section 306 or 307 of title 1, United States Code). (B) Separate coverage or plan for gender-affirming care allowed (i) Option to purchase separate coverage or plan Nothing in subparagraph (A) shall be construed as prohibiting any employer from purchasing for its employees separate coverage for gender-affirming care described in such subparagraph, or a health plan that includes such gender-affirming care, so long as no credit is allowed under this section with respect to the employer contributions for such coverage or plan and such coverage does not cover any practice that would be subject to penalty under section 2260B of title 18, United States Code. (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-affirming care described in such subparagraph, or a plan that includes such gender-affirming care, so long as such separate coverage or plan is not paid for with any employer contribution eligible for the credit allowed under this section and such coverage or plan does not cover any practice that would be subject to penalty under section 2260B of title 18, United States Code. . (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: (8) Coverage consistent with Federal policy regarding gender-affirming care In entering into contracts under this subsection, the Director shall ensure that no multi-State qualified health plan offered in an Exchange provides health benefits coverage for which the expenditure of Federal funds is prohibited under chapter 4 of title 1, United States