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Insurance Commissioner calls for health insurers to end discrimination based on gender identity

Insurance Commissioner Mike 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).

If a health insurer covers medically necessary services for its enrollees, it cannot deny those services for a transgender person solely on the basis of a person’s gender status.

Future regulatory steps will depend on the response of insurers to today’s letter and the number and nature of consumer complaints received in response to today’s announcement.

“Transgender people are entitled to the same access to health care as everyone else,” said Insurance Commissioner Mike Kreidler. “Whether specific services are considered medically necessary should be up to the provider to decide on behalf of their patient.”

While Washington state insurance law doesn’t require insurance companies to cover sexual reassignment surgery, it also doesn’t prevent insurers from adding this coverage if they chose to do so.

Health insurers are required to cover procedures that are part of a gender transition process if they’re covered for other policyholders for different reasons. Examples of such services include:

 

  • Hormone therapy
  • Counseling services
  • Gender transition process
  • Mastectomy
  • Breast augmentation and reconstruction

Currently, some insurers have exclusions for all transgender services. Today’s announcement makes it clear that disparate access to these and other medical services is not allowed.

Many large employers in Washington state, including Boeing, Amazon, Microsoft, Nordstrom, and the city of Seattle have already taken action to prevent discrimination against transgender employees in their health coverage. Medicare recently lifted the ban on coverage for sex reassignment surgery and Washington’s Health Care Authority is looking into what steps it can take to ensure coverage for medically necessary services.

“Health insurance policies that discriminate against any group of people cause significant harm by preventing people from receiving basic health care,” said Insurance Commissioner Mike Kreidler. “I expect the health insurers doing business in our state to meet a high standard of equity and fairness. All policyholders deserve to get the medical services they need and have paid a premium for.”

Kreidler’s office is currently reviewing all 2015 individual and small employer health plans to determine if they contain any discriminatory exclusions and to make sure they cover medically necessary services equally for non-transgender and transgender enrollees.

Anyone who believes they’ve been unfairly denied medical services by their health insurer should file a complaint with the insurance commissioner’s office or call our consumer hotline at 1-800-562-6900.

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