The following U.S. states prohibit anti-trans discrimination in health insurance and legally require insurance companies to provide transgender health coverage:
January 2013 — Oregon removes barriers to transition-related care
- Health insurers may not categorically exclude transgender patients from coverage.
- Health insurers must provide coverage and cannot deny coverage of treatments for transgender policy holders if the same treatments are covered for other policy holders.
- Health insurers may not deny treatment on the basis of a policy holder’s actual or perceived gender. That means that all policy holders can rely on annual exams, cancer screenings, and gender-specific health care, regardless of their gender on file.
- The statewide mandate for coverage of mental health services must apply to transgender patients.
The DMHC letter directs health plans to remove benefit and coverage exclusions related to gender transition as well as limitations based on gender identity or gender expression. This development should ensure parity in coverage, and significantly increase medically necessary services available to transgender people.
The new Director’s Letter also allows transgender people to access DMHC’s Independent Medical Review (IMR) process if a health plan denies a specific medical service or treatment. Before the Director’s Letter, transition-related care was classified as a coverage exclusion and was ineligible for the independent medical review.
The announcement of this bulletin (B-4.49) means that in order to comply with current Colorado statutes prohibiting discrimination based on sexual orientation and transgender status, health insurance plans sold in Colorado can no longer:
- impose higher rates or charge more because of an applicant’s sexual orientation (see definition below);
- use an individual’s sexual orientation as a pre-existing condition for the purpose of limiting or denying coverage; or
- deny, exclude or limit coverage for medically necessary services as determined by an individual’s medical provider, if the same item or service would be provided — based on current standards of care — to another individual without regard to their sexual orientation.
Vermont’s Division of Insurance, under the Department of Financial Regulation (DFR), issued a bulletin effective April 22, that directs insurance companies to end the practice immediately, and explicitly states that all insurance plans submitted for Vermont’s Health Benefit Exchange are also disallowed from using these discriminatory exclusions.
The bulletin prohibits a health insurer from implementing blanket policy exclusions for transition-related care. Insurers will still be allowed to evaluate the medical necessity of any given treatment on a case by case basis, much like they’d evaluate any other insurance claim.
Today, the District of Columbia advanced the rights of the city’s transgender community by prohibiting discrimination in health insurance based on gender identity and expression. Mayor Vincent C. Gray announced the Department of Insurance, Securities, and Banking (DISB) is issuing a bulletin to District health insurance companies addressing the application of anti-discrimination provisions in the insurance code, including recognizing gender dysphoria, or gender identity disorder, as a recognized medical condition.
This action follows DISB’s March 15, 2013 bulletin notifying health insurers to remove language that discriminated on the basis of gender identity and expression from their policies and permit those with gender dysphoria to obtain medically necessary benefits. Today’s action goes one step further in protecting this community’s health insurance rights by affirming that gender dysphoria is a recognized medical condition and thereby treatment, including gender reassignment surgeries, is a covered benefit.
Starting this year, both MassHealth and the state’s private insurance companies will begin offering coverage of transition-related care for the state’s transgender residents.
“If [an insurance] carrier refuses to cover medically necessary treatment because the insured failed to conform to the carrier’s idea of how a man or a woman should look or behave, then the insured has been discriminated against based on the individual’s sex,” the guideline reads in part. “Thus, denying medically necessary treatment based on an individual’s gender identity or gender dysphoria is prohibited sex discrimination under Massachusetts law.”
“Therefore, the Division has concluded that excluding coverage for gender identity or gender dysphoria-related treatment will be considered prohibited sex discrimination because it would be a limitation on coverage based on the sex of the insured,” concludes the directive.
Washington State Insurance Commissioner Mike Kreidler made an announcement clarifying that health insurance policies sold in Washington cannot discriminate against transgender Washingtonians. Commissioner Kreidler is “asking all health insurers doing business in Washington state to end discrimination in health insurance based on gender identity and related medical conditions. In a letter sent to health insurers this morning, Kreidler reminded health insurers that exclusions and denials of coverage on the basis of gender identity are against the Washington Law Against Discrimination (RCW 49.60) and the federal Affordable Care Act (Section 1557).”
The Illinois Department of Insurance for taking a crucial first step in addressing discrimination against transgender Illinoisans in insurance coverage. The bulletin issued to private insurers in the state notes that many insurance plans sold in Illinois may not discriminate against transgender people and must provide them coverage for the same medical treatment available for non-transgender policy holders. The Bulletin cites current Illinois law and the federal Affordable Care Act, both of which prohibit discrimination by insurers against transgender people because of their gender identity.
In a letter being sent to insurance companies this week, NY Gov. Andrew M. Cuomo said that because state law requires insurance coverage for the diagnosis and treatment of psychological disorders, people who are found to have a mismatch between their birth sex and their internal sense of gender are entitled to insurance coverage for treatments related to that condition, called gender dysphoria.
March 28, 2016 – Delaware Becomes 15th State to Ban Trans Health Exclusions
Delaware’s insurance bulletin states that under the Delaware Unfair Trade practices act, insurance plans sold in Delaware may not maintain “any blanket policy exclusion” for transition-related care. Plans also may not “deny, exclude, or otherwise limit coverage for medically necessary services” for gender transition if those services are covered for other medical conditions.
Pennsylvania’s guidance is based on the state’s longstanding law against unfair insurance practices, as well as federal law and regulations prohibiting gender-based discrimination. It states that in order to comply with these laws, insurance companies have to get rid of categorical exclusions that say that transition-related care is not covered. The guidance also says that insurance companies also can’t refuse to cover a service like surgeries or hormone treatments simply because it’s being used to help someone transition.
Also: Michigan, Minnesota, Montana, Nevada, Rhode Island
Which state will be next? Check back for updates!
Last updated: 12/06/16