State Health Insurance Laws and Guidance (Archived)
Many states prohibit health insurance plans from denying coverage for health care simply because it is transgender-related. In most cases, this means that explicit exclusions for transgender health care are prohibited in these jurisdictions. To learn about these state health insurance laws, see the Movement Advancement Project’s interactive map.
These protections will not apply to all health plans in a given state. See our Trans Health Insurance Tutorial section on Understanding Your Plan for more details.
The Trans Health Project historically compiled information on state laws and guidance prohibiting transgender-related health insurance discrimination. Below is an archive of past state insurance policies compiled by the Trans Health Project. Please see the time stamp under each state to see when the information was last updated.
Alabama
Alabama has no explicit insurance guidance on transgender-related health care.
Last updated on Feb 23, 2020.
Alaska
Alaska has no explicit insurance guidance on transgender-related health care.
Last updated on Feb 23, 2020.
Arizona
Arizona has no explicit insurance guidance on transgender-related health care.
Last updated on Feb 23, 2020.
Arkansas
Arkansas has no explicit insurance guidance on transgender-related health care.
Last updated on Feb 23, 2020.
California
California has explicit insurance guidance on transgender-related health care.
Statutes:
- Cal. Insurance Code § 10140
-
Cal. Health & Safety Code § 1365.5
Summary:
Prohibits exclusions based on sex, including transgender status.
Regulations
-
Cal. Code Regs. tit 10, §§ 2561.1-2561.2
Summary:
Prohibits insurance coverage limitations based on transgender status.
Bulletins and Announcements:
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Announcement: Economic Impact Statement - Gender Nondiscrimination in Health Insurance
Issued by: California Department of Insurance
Issued on: April 13, 2012
Summary:
This document assessed the cost associated with adopting regulations that prohibited transgender exclusions. It concluded the regulation would "cost little or nothing in the short run and may produce longer-term cost savings and improved health benefits for transgender people."
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Guidance: Department of Managed Health Care, Letter No. 12-K, Gender Nondiscrimination Requirements
Issued by: Department of Managed Health Care
Issued on: April 9, 2013
Summary:
Notes that exclusions for medically necessary “gender transition services” are discriminatory and should be removed from all managed care plans.
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Guidance: Compliance with Health Insurance Antidiscrimination Protections in California Law
Issued by: Insurance Commissioner Ricardo Lara
Issued on: June 15, 2020
Summary:
The purpose of this Notice is to remind California health insurers that the above-referenced federal rule does not preempt state law. Health insurance regulated by the California Department of Insurance (Department) remains subject to California’s antidiscrimination law. Consequently, health insurers must continue to comply with the existing antidiscrimination standards in California law, beyond the minimum requirements of federal law.
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Announcement: Commissioner Lara calls on Trump administration to stop undermining health care protections for transgender Californians
Issued by: California Insurance Commissioner Ricardo Lara
Issued on: August 5, 2019
Summary:
California Insurance Commissioner Ricardo Lara, together with 17 state insurance commissioners, announced he is submitting a letter to U.S. Secretary of Health and Human Services, Alex Azar, urging the Trump administration to protect rules addressing unfair treatment of transgender consumers.
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Announcement: Statement of Commissioner Lara on Trump Administration reversing LGBTQ health protections
Issued by: California Insurance Commissioner Ricardo Lara
Issued on: June 12, 2020
Summary:
Statement in response to the Trump Administration reversing non-discrimination protections under Section 1557 of the Affordable Care Act.
-
Issued by: California Insurance Commissioner Ricardo Lara
Issued on: October 4, 2022
Enforcement Actions:
Consumer Complaints:
You can file a complaint with the California Department of Insurance or the California Department of Managed Care, depending on your type of plan.
Consumer complaints are separate from the appeals process. They are appropriate for things such as unfair discrimination, billing problems, cancellation of coverage, claim and copay disputes, and network adequacy issues.
Last updated on Mar 6, 2023.
Colorado
Colorado has explicit insurance guidance on transgender-related health care.
Regulations
-
10 Colo. Code Regs. § 2505-10:8.700
Summary:
In Federally Qualified Health Centers and Women’s Health Services, patients with a clinical diagnosis of gender dysphoria are eligible for the transgender services benefit, subject to the service-specific criteria and restrictions detailed in section 8.735.5
-
10 Colo. Code Regs. § 2505-10:8.735
Summary:
It covers a select number of gender affirming procedures, subject to the service-specific criteria and restrictions detailed in Section 8.735.4, but does not include facial gender confirmation surgeries.
Bulletins and Announcements:
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Issued by: Colorado Department of Regulatory Agencies, Division of Insurance
Issued on: March 18, 2013
Summary:
Interprets insurance non-discrimination law to prohibit the denial, exclusion, or limitation of “coverage for medically necessary services . . . if the item or service would be provided based on current standards of care to another individual without regard to their sexual orientation,” which is defined in Colorado to include “transgender status.”
Last updated on Jan 30, 2023.
Connecticut
Connecticut has explicit insurance guidance on transgender-related health care.
Bulletins and Announcements:
-
Bulletin: Bulletin IC-34, Gender Identity Nondiscrimination Requirements (2013)
Issued by: Connecticut Insurance Department
Issued on: December 19, 2013
Summary:
The bulletin notes that “a blanket policy exclusion for gender transition and related services is prohibited.”
-
Announcement: Connecticut Insurance Commissioner Calls on Secretary Azar to Stop Discriminatory Changes to the Affordable Care Act
Issued by: Commissioner Mais
Issued on: August 5, 2019
-
Announcement: Insurance Commissioner: Connecticut LGBTQ health care consumers remain protected from discrimination
Issued by: Commissioner Mais
Issued on: June 18, 2020
Enforcement Actions:
-
Connecticut Commission on Human Rights and Opportunities ruling
Summary:
The Connecticut Commission on Human Rights and Opportunities issued a ruling prohibiting all employers and insurers from denying coverage for any treatments related to gender transition. It also specifically found exclusions for facial gender reassignment surgery to be unlawful.
Last updated on Jan 30, 2023.
Delaware
Delaware has explicit insurance guidance on transgender-related health care.
Statutes:
- 18 DE Code § 2304 (2012)
Regulations
-
Code Del. Regs. 1308 Appendix A
Summary:
(Applicable to both Basic and Standard Indemnity Benefit Plans). This regulation is implementing a chapter on Small Employer Health Insurance stating that a small employer carrier shall issue a basic health benefit or standard health benefit plan if certain requirements are met. 18 Del. C. § 7207.
- Excluding “any treatment leading to or in conjunction with transsexualism, sex changes or modification, including but not limited to surgery.”
Bulletins and Announcements:
-
Bulletin: The Gender Identity Nondiscrimination Act of 2013
Issued by: Commissioner Navarro
Issued on: September 4, 2023
Summary:
“The Department further expects that determinations of medical necessity, eligibility, and prior authorization requirements for diagnoses related to an insured’s gender identity will continue to be based on current medical standards established by nationally recognized transgender health medical experts. The failure to recognize such standards in making such determinations qualifies as a violation of the Unfair Trade Practices Act.”
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Bulletin: Domestic/Foreign Insurers Bulletin No. 86, The Gender Identity Nondiscrimination Act of 2013 (2016)
Issued by: Delaware Department of Insurance
Issued on: March 23, 2016
Summary:
Prohibiting “any blanket policy exclusion for gender dysphoria, gender identity disorder, medically necessary surgeries or other treatments related to gender transition or related services”.
Last updated on Feb 6, 2023.
District of Columbia
District of Columbia has explicit insurance guidance on transgender-related health care.
Statutes:
-
DC Official Code § 31-2233.11, Unfair Discrimination (2022)
Summary:
“No person shall refuse to insure, refuse to continue to insure, or limit the amount of coverage available to an individual because of marital status, race, color, personal appearance, sexual orientation, gender identity or expression, matriculation, political affiliation, or an individual’s status as a victim of an intrafamily offense, sexual assault, dating violence, or stalking."
Bulletins and Announcements:
-
Issued by: Commissioner McPherson
Issued on: February 27, 2014
Summary:
“In determining the medical necessity of services and benefits provided to such patients, insurance companies should refer to the recognized professional standard of medical care for transgender individuals requiring treatment for gender dysphoria, which is enumerated in the most recent edition of the World Professional Association for Transgender Health Standards of Care (“WPATH Standards”).”
-
Issued by: District of Columbia Department of Insurance, Securities and Banking
Issued on: March 15, 2013
Summary:
Exclusions for services related to sex reassignment violate DC's prohibition on discrimination based on gender identity or expression and are no longer enforceable.
Last updated on Feb 6, 2023.
Florida
Florida has no explicit insurance guidance on transgender-related health care.
Last updated on Feb 23, 2020.
Georgia
Georgia has no explicit insurance guidance on transgender-related health care.
Last updated on Feb 23, 2020.
Hawaii
Hawaii has explicit insurance guidance on transgender-related health care.
Statutes:
-
Summary:
“Prohibits health insurers, mutual benefit societies, and health maintenance organizations from applying categorical cosmetic or blanket exclusions to gender affirming treatments or procedures when determined to be medically necessary pursuant to applicable law and specifies a process for appealing a claim denied on the basis of medical necessity. Requires those entities to provide applicants and insured persons with clear information about the coverage of gender transition services, including the process for appealing a claim denied on the basis of medical necessity.”
- Haw. Rev. Stat. § 432D - (HMO)
- Haw. Rev. Stat. § 432:1 - (individual and group hospital and medical service policy)
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Haw. Rev. Stat. § 431:10A - (individual and group accident and health or sickness policy)
Summary:
“(4) Denying, canceling, or limiting coverage for services on the basis of actual gender identity or perceived gender identity including but not limited to the following:
(A) Health care services related to gender transition; provided that there is coverage under the policy, contract, plan, or agreement for the services when the services are not related to gender transition; and
(B) Health care services that are ordinarily or exclusively available to individuals of one sex.”
Last updated on Feb 6, 2023.
Idaho
Idaho has no explicit insurance guidance on transgender-related health care.
Last updated on Feb 23, 2020.
Illinois
Illinois has explicit insurance guidance on transgender-related health care.
Regulations
-
Ill. Admin. Code tit. 50, § 2603.35 (Prohibited Gender Identity Discrimination)
Summary:
“A company that offers or provides group or individual health insurance coverage that is neither a grandfathered plan nor a plan offering excepted benefits shall not discriminate on the basis of an insured's or prospective insured's actual or perceived gender identity, or on the basis that the insured or prospective insured is a transgender person.”
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Ill. Admin. Code tit. 50, § 2007.60 (allows exclusions of GRS and cosmetic surgery)
Summary:
Exclusions:
Excluding, “Sex change surgery, with respect to excepted benefit policies and grandfathered health plans, or surgical sterilization” and “ Cosmetic surgery, except that “cosmetic surgery” shall not include reconstructive surgery when the service is incidental to or follows surgery resulting from trauma, infection or other diseases of the involved part”
Bulletins and Announcements:
-
Bulletin: Guidance Relating to Nondiscrimination in Healthcare Services in Illinois
Issued by: Illinois Department of Human Rights (IDHR), the Illinois Department of Healthcare and Family Services (HFS) and Illinois Department of Insurance (IDOI)
Issued on: June 26, 2020
Summary:
Clarifies protections under the Illinois Human Rights Act, in insurance, and Medicaid.
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Issued by: Illinois Department of Insurance
Issued on: June 15, 2020
Summary:
Reminding insurers subsequent to the announcement of the repeal of Section 1557 regulations that they are still subject to Illinois' prohibitions on transgender discrimination in insurance.
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Bulletin: Company Bulletin 2014-10, Healthcare for Transgender Individuals (2014)
Issued by: Illinois Department of Insurance
Issued on: July 28, 2014
Summary:
Prohibiting discriminatory exclusionary clauses that have “the effect of targeting transgender persons or persons with gender dysphoria such as: ‘Any treatment or procedure designed to alter an individual’s physical characteristics to those of the opposite sex.’ ‘Sex transformations and related services.’ ".
Last updated on Feb 6, 2023.
Indiana
Indiana has no explicit insurance guidance on transgender-related health care.
Last updated on Feb 23, 2020.
Iowa
Iowa has no explicit insurance guidance on transgender-related health care.
Last updated on Feb 23, 2020.
Kansas
Kansas has no explicit insurance guidance on transgender-related health care.
Last updated on Feb 23, 2020.
Kentucky
Kentucky has no explicit insurance guidance on transgender-related health care.
Last updated on Feb 23, 2020.
Louisiana
Louisiana has no explicit insurance guidance on transgender-related health care.
Last updated on Feb 23, 2020.
Maine
Maine has explicit insurance guidance on transgender-related health care.
Statutes:
-
Summary:
Nondiscrimination. An individual may not, on the basis of race, color, national origin, sex, sexual orientation, gender identity, age or disability, be excluded from participation in, be denied benefits of or otherwise be subjected to discrimination under any health plan offered in accordance with this Title. A carrier may not in offering, providing or administering a health plan:
A. Deny, cancel, limit or refuse to issue or renew a health plan or other health-related coverage, deny or limit coverage of a claim or impose additional cost sharing or other limitations or restrictions on coverage on the basis of race, color, national origin, sex, sexual orientation, gender identity, age or disability;
B. Have or implement marketing practices or benefit designs that discriminate on the basis of race, color, national origin, sex, sexual orientation, gender identity, age or disability in a health plan or other health-related coverage;
C. Deny or limit coverage, deny or limit coverage of a claim or impose additional cost sharing or other limitations or restrictions on coverage for any health services that are ordinarily or exclusively available to individuals of one sex to a transgender individual based on the fact that the individual's sex assigned at birth, gender identity or gender otherwise recorded is different from the one to which such health services are ordinarily or exclusively available;
D. Have or implement a categorical coverage exclusion or limitation for all health services related to gender transition;
E. Otherwise deny or limit coverage, deny or limit coverage of a claim or impose additional cost sharing or other limitations or restrictions on coverage for specific health services related to gender transition if such denial, limitation or restriction results in discrimination against a transgender individual.
Bulletins and Announcements:
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Bulletin: Bulletin 437: Incorporation of the Affordable Care Act’s Consumer Protections into Maine Law
Issued by: Maine Bureau of Insurance
Issued on: July 23, 2019
Summary:
"Protections for transgender individuals include a prohibition against categorical coverage exclusions or limitations for all health services related to gender transition, and a prohibition against the arbitrary imposition of sex-specific or gender-specific coverage limitations or cost sharing."
Consumer Complaints:
If you have been denied coverage for transgender-related health care under an insurance plan issued in Maine due to an exclusion, you can file a complaint with the Maine Bureau of Insurance.
Last updated on Aug 2, 2022.
Maryland
Maryland has explicit insurance guidance on transgender-related health care.
Bulletins and Announcements:
-
Issued by: Maryland Insurance Administration
Issued on: December 10, 2015
Summary:
Prohibiting student health plans from excluding treatment for gender dysphoria.
Last updated on Feb 23, 2020.
Massachusetts
Massachusetts has explicit insurance guidance on transgender-related health care.
Bulletins and Announcements:
-
Issued by: Commissioner Anderson
Issued on: September 9, 2021
Summary:
“Carriers may not categorically exclude services used in the treatment of gender dysphoria when those services are medically necessary or when the same services are covered for the treatment of other conditions. Carriers should consult the most up-to-date medical standards set forth by nationally recognized medical experts in the transgender health field, including but not limited to those issued by the World Professional Association for Transgender Health (WPATH). Carriers may not single out a treatment or procedure for exclusion of coverage because of its association with transgender people or with gender dysphoria. Additionally, where a treatment is considered medically necessary for a patient, other procedures required in preparation for, as a component of, as a follow-up to, or as a revision of the treatment should also be considered medically necessary and should not be denied based on an individual’s gender identity or because the services are being used in the treatment of gender dysphoria. Carriers may not impose requirements for coverage of a service when used to treat or ameliorate symptoms of gender dysphoria than when used to treat other conditions.”
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Issued by: Massachusetts Office of Consumer Affairs and Business Regulation, Division of Insurance
Issued on: June 20, 2014
Summary:
“...[D]enying medically necessary treatment based on an individual’s gender identity of gender dysphoria is sex discrimination under Massachusetts law."
Last updated on Feb 6, 2023.
Michigan
Michigan has explicit insurance guidance on transgender-related health care.
Bulletins and Announcements:
-
Bulletin: 2023 Form and Rate Filing Requirements for Medical Plans
Issued by: Director Fox
Issued on: March 22, 2022
Summary:
“DIFS will review policy and certificate forms for compliance with all provisions of federal and state antidiscrimination law, including but not limited to section 1557 of the Affordable Care Act, 42 USC 18116. Issuers are encouraged to review in its entirety the Final Rule on Nondiscrimination in Health Programs and Activities, which is set forth at 45 CFR Part 92 (Final Rule). The Final Rule prohibits discrimination on the basis of race, color, national origin, sex, age, disability, gender identity, and sexual orientation.”
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Bulletin: Bulletin 2016-10-INS, 2017 Form and Rate Filing Requirements for Medical Plans (2016)
Issued by: Michigan Department of Insurance and Financial Services
Issued on: March 14, 2016
Notes:
Additionally, Bulletin 2017-05-INS, 2018 Form and Rate Filing Requirements for Medical Plans (2017) notes, "DIFS will review policy and certificate forms for compliance with all provisions of federal and state anti-discrimination law, including but not limited to Section 1557 of the Affordable Care Act, 42 USC 18116."
Last updated on Feb 6, 2023.
Minnesota
Minnesota has explicit insurance guidance on transgender-related health care.
Statutes:
-
Minnesota Statutes Section 363A.17
Summary:
“It is an unfair discriminatory practice for a person engaged in a trade or business or in the provision of a service: ... (3) to intentionally refuse to do business with, to refuse to contract with, or to discriminate in the basic terms, conditions, or performance of the contract because of a person's race, national origin, color, sex, sexual orientation, or disability, unless the alleged refusal or discrimination is because of a legitimate business purpose.”
Bulletins and Announcements:
-
Bulletin: Gender Identity Nondiscrimination Requirements
Issued by: Minnesota Department of Commerce
Issued on: December 30, 2021
Summary:
“The Departments would disapprove policy forms filed by insurers if there are exclusions on coverage for medically necessary treatment for gender dysphoria and related health conditions, including gender confirmation surgery—including medically necessary procedures to conform secondary sex characteristics to a person’s gender identity or expression... The Departments will also continue to conduct independent reviews for denials of coverage on the basis that services are not medically necessary via the Departments’ external review programs. Determination of medical necessity and prior authorization protocols for gender dysphoria-related treatment must be based on the most recent, published medical standards set forth by nationally recognized medical experts in the transgender health field.”
Last updated on Feb 6, 2023.
Mississippi
Mississippi has no explicit insurance guidance on transgender-related health care.
Last updated on Feb 23, 2020.
Missouri
Missouri has no explicit insurance guidance on transgender-related health care.
Last updated on Feb 23, 2020.
Montana
Montana has explicit insurance guidance on transgender-related health care.
Bulletins and Announcements:
-
Issued by: Montana Commissioner of Securities & Insurance
Issued on: April 14, 2022
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Guidance: Addendum to April 14, 2022 Advisory Memorandum
Issued by: Montana Commissioner of Securities & Insurance
Issued on: May 13, 2022
Last updated on Mar 6, 2023.
Nebraska
Nebraska has no explicit insurance guidance on transgender-related health care.
Last updated on Feb 23, 2020.
Nevada
Nevada has explicit insurance guidance on transgender-related health care.
Regulations
-
NAC 686A.110 – 686.160
Summary:
“Restricting, reducing, modifying or excluding benefits relating to coverage involving the genital organs of only one sex when the restriction, reduction, modification or exclusion is not required for both sexes.” NAC 686A.140(7).
Bulletins and Announcements:
-
Issued by: Nevada Department of Business and Industry, Division of Insurance
Issued on: June 25, 2015
Summary:
“prohibiting 'the denial, exclusion, or limitation of benefits relating to coverage of medically necessary health care services on the basis of sex as it relates to gender identity or expression.'”
Last updated on Mar 6, 2023.
New Hampshire
New Hampshire has explicit insurance guidance on transgender-related health care.
Statutes:
-
Summary:
"Discrimination on the basis of gender identity with respect to the availability of any covered services, medications, supplies, or durable medical equipment is specifically prohibited."
-
Summary:
"Discrimination on the basis of gender identity with respect to the availability of any covered services, medications, supplies, or durable medical equipment is specifically prohibited."
Bulletins and Announcements:
-
Bulletin: Gender Identity Discrimination Prohibited
Issued by: New Hampshire Insurance Department Commissioner
Issued on: June 8, 2020
Summary:
The Department considers any blanket policy exclusions for health care services related to gender transition or any other form of gender dysphoria treatment as a violation of state nondiscrimination law in that such exclusions discriminate on the basis of gender identity.
Last updated on Jun 10, 2020.
New Jersey
New Jersey has explicit insurance guidance on transgender-related health care.
Statutes:
-
N.J.S.A. 17:48A-7ll(4)(a-b)
Summary:
Prohibits denying or limited coverage for services related to gender identity. Includes hormone therapy, hysterectomy, mastectomy, and vocal training explicitly.
-
2016 S.B. 3017, N.J. 217th Legislature - Second Annual Session (enacted July 21, 2017)
Summary:
This legislation prohibits health insurers and health maintenance organizations, as well as health benefits plans or contracts which are issued or purchased pursuant to the New Jersey Individual Health Coverage Program, New Jersey Small Employer Health Benefits Program, State Health Benefits Program, School Employees’ Health Benefits Program, and the Medicaid Program from discriminating in the provision of coverage on the basis of gender identity or expression. This bill also prohibits contracts between certain health care providers who provide health care services to the State’s inmate population, such as University Correctional Health Care, and the New Jersey Department of Corrections, the Juvenile Justice Commission, the State Parole Board, or any other State or local entity from discriminating in the provision of coverage on the basis of gender identity or expression.
Last updated on Feb 6, 2023.
New Mexico
New Mexico has explicit insurance guidance on transgender-related health care.
Regulations
-
N.M. Admin. Code 13.10.32.13
Summary:
“An Insurer who is legally obligated to provide contraceptive supplies or services shall do so without discriminating against the covered person on the basis of race, color, national origin, sex, sexual orientation, gender expression or identity, marital status, age, citizenship, immigration status, or disability. This includes, but is not limited to, providing coverage for of any method of over-the-counter contraception without regard to the sex, or gender identity or expression, of the covered person.”
Bulletins and Announcements:
-
Bulletin: New Mexico Superintendent of Insurance committed to protecting civil rights in health care
Issued by: Office of Superintendent of Insurance
Issued on: May 13, 2020
Summary:
This is a statement regarding the Section 1557 rollback rule, stating that NM would continue to exercise its authority under the NM Human Rights Act and NM Insurance Code.
-
Bulletin: Transgender Non-Discrimination in Health Insurance Benefits
Issued by: New Mexico Office of Superintendent of Insurance
Issued on: August 23, 2018
Summary:
Interpreting the Affordable Care Act, New Mexico Human Rights Act and New Mexico Insurance Code to prohibit health care services related to gender transition when the services are otherwise covered under the policy. It also prohibits denials of sex-specific care.
Last updated on Feb 6, 2023.
New York
New York has explicit insurance guidance on transgender-related health care.
Regulations
-
Summary:
"Discrimination because of sex shall include discrimination on the basis of pregnancy, false pregnancy, termination of pregnancy, or recovery therefrom, childbirth or related medical conditions, sex stereotyping, sexual orientation, gender identity or expression, and transgender status."
- 11 NYCRR 52.75
Bulletins and Announcements:
-
Issued by:
Issued on: February 21, 2021
-
Issued by:
Issued on: June 28, 2020
Summary:
“Section 52.75(a)(2) provides that discrimination prohibited by § 52.75 includes denying, limiting, or otherwise excluding medically necessary services or treatment otherwise covered by a policy or contract on the basis that the treatment is for gender dysphoria. An issuer must provide an insured with the utilization review appeal rights required by Insurance Law and Public Health Law Articles 49 for gender dysphoria treatment that is denied based on medical necessity. Exclusions are not permitted for specific care or treatment unless such exclusions are permitted under § 52.16(c). While § 52.16(c) permits an exclusion for cosmetic surgery, any denial of a service as cosmetic is a medical necessity denial, as set forth in § 56.0 and subject to internal and external appeal rights under Insurance Law and Public Health Law Articles 49. Thus, an issuer may not deny a specific procedure to treat gender dysphoria on the basis that such procedure is deemed always cosmetic or experimental or investigational for all insureds without conducting an internal review and providing external appeal rights."
-
Bulletin: Discrimination Based on Sexual Orientation, Gender Identity or Expression, or Transgender Status
Issued by:
Issued on: July 23, 2019
-
Bulletin: Discrimination Based on Sexual Orientation, Gender Identity and/or Gender Dysphoria
Issued by:
Issued on: June 15, 2018
-
Bulletin: Coverage for Health Services Provided to Transgender Individuals
Issued by:
Issued on: August 16, 2017
-
Issued by: New York Department of Financial Services
Issued on: December 11, 2014
Summary:
Noting that “[a]n issuer of a policy that includes coverage for mental health conditions may not exclude coverage for the diagnosis and treatment of gender dysphoria,” and noting that Insurance Regulation 62 “prohibits an insurer from limiting coverage by type of illness, treatment, or medical condition. See 11 NYCRR § 52.16(c).”
The Letter also notes that categorical exclusions for treatments of gender dysphoria are unlawful under the following laws:
- Mental Health Parity and Addiction Equity Act of 2008
- N.Y. Civ. Serv. Law Article 11
- N.Y. Ins. Law §§ 3221 and 4303 and Article 49
- N.Y. Pub. Health Law Article 49
- Chapter 748 of the Laws of 2006, as amended by Chapter 502 of the Laws of 2007
- 45 C.F.R. § 146.136
Enforcement Actions:
Last updated on Jul 5, 2023.
North Carolina
North Carolina has no explicit insurance guidance on transgender-related health care.
Last updated on Feb 23, 2020.
North Dakota
North Dakota has no explicit insurance guidance on transgender-related health care.
Last updated on Feb 23, 2020.
Ohio
Ohio has no explicit insurance guidance on transgender-related health care.
Last updated on Feb 23, 2020.
Oklahoma
Oklahoma has no explicit insurance guidance on transgender-related health care.
Last updated on Feb 23, 2020.
Oregon
Oregon has explicit insurance guidance on transgender-related health care.
Statutes:
-
Summary:
"SECTION 2. Except as otherwise provided for in the Insurance Code, an individual may not, on the basis of actual or perceived race, color, national origin, sex, sexual orientation, gender identity, age or disability, be excluded from participation in, be denied the benefits of or otherwise be subjected to discrimination under any health benefit plan issued or delivered in this state."
Regulations
-
Summary:
“Except as otherwise provided for in the Insurance Code, an individual may not, on the basis of actual or perceived race, color, national origin, sex, sexual orientation, gender identity, age or disability, be excluded from participation in, be denied the benefits of or otherwise be subjected to discrimination under any health benefit plan issued or delivered in this state. [2019 c.285 §2]”
Bulletins and Announcements:
-
Bulletin: Nondiscrimination Related to Transgender Persons in the Transaction of Insurance in Oregon
Issued by: Oregon Insurance Division
Issued on: September 7, 2016
Last updated on Mar 6, 2023.
Pennsylvania
Pennsylvania has explicit insurance guidance on transgender-related health care.
Bulletins and Announcements:
-
Bulletin: Protecting Pennsylvanians from Conversion Therapy and Supporting LGBTQIA+ Pennsylvanians
Issued by: Governor of Pennsylvania
Issued on: August 16, 2022
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Bulletin: Notice Regarding Nondiscrimination, Notice 2016-05, 46 Pa. Bulletin 2251
Issued by: Pennsylvania Bureau of Life, Accident and Health, Office of Insurance Product Regulation
Issued on: April 30, 2015
Summary:
Interpreting The Insurance Company Law of 1921, the Unfair Insurance Practices Act, and Section 1557 of the Affordable Care Act to mean that "a policy will not exclude services based on gender identity and will not contain a categorical exclusion of coverage for all health services related to gender transition, as described in the OCR Proposed Rule, and also will affirmatively provide that medically necessary covered services will be available to a policyholder regardless of their gender identity."
Last updated on Mar 6, 2023.
Rhode Island
Rhode Island has explicit insurance guidance on transgender-related health care.
Bulletins and Announcements:
-
Issued by: Rhode Island Office of the Health Insurance Commissoner
Issued on: November 23, 2015
Summary:
“[D]enial, exclusion, or other limitations of coverage by a health insurer for medically necessary treatment otherwise covered by a health insurance policy or contract based solely on an individual’s gender identity, expression or gender dysphoria is sex discrimination prohibited under Rhode Island law.”
Notes:
Separately, Rhode Island General Law Sections 27-18-30, 27-19-23, 27-20-20 and 27-41-33 require the coverage of fertility preservation when medical treatment--such as hormones or surgery--will render an individual infertile.
Last updated on Aug 2, 2022.
South Carolina
South Carolina has no explicit insurance guidance on transgender-related health care.
Last updated on Feb 23, 2020.
South Dakota
South Dakota has no explicit insurance guidance on transgender-related health care.
Last updated on Feb 23, 2020.
Tennessee
Tennessee has no explicit insurance guidance on transgender-related health care.
Last updated on Feb 23, 2020.
Texas
Texas has no explicit insurance guidance on transgender-related health care.
Last updated on Feb 23, 2020.
Utah
Utah has no explicit insurance guidance on transgender-related health care.
Last updated on Feb 23, 2020.
Vermont
Vermont has explicit insurance guidance on transgender-related health care.
Bulletins and Announcements:
-
Issued by: Vermont Department of Financial Regulation, Division of Insurance
Issued on: June 19, 2019
Summary:
Health plans “shall not exclude coverage for medically necessary treatment including gender affirmation surgery for gender dysphoria and related health conditions. In addition, insurers may not deny coverage of gender affirmation surgery as not medically necessary on the basis of age without other clinical factors or circumstances supporting the decision."
Last updated Feb 23, 2020.
Virginia
Virginia has explicit insurance guidance on transgender-related health care.
Statutes:
-
Summary:
Prohibited discrimination based on gender identity or status as a transgender individual.
A. As used in this section:
"Gender identity" means an individual's internal sense of gender, which may be male, female, neither, or a combination of male and female and which may be different from an individual's sex assigned at birth.
"Medically necessary transition-related care" means any medical treatment prescribed by a licensed physician for treatment of gender dysphoria and includes (i) outpatient psychotherapy and mental health services for gender dysphoria and associated co-morbid psychiatric diagnoses; (ii) continuous hormone replacement therapy; (iii) outpatient laboratory testing to monitor continuous hormone therapy; and (iv) gender reassignment surgeries.
"Transgender individual" means an individual whose gender identity is different from the sex assigned to that individual at birth.
B. A health carrier offering a health benefit plan providing individual or group health insurance coverage shall:
- Provide coverage under the health benefit plan without discrimination on the basis of gender identity or status as a transgender individual; and
- Treat covered individuals consistent with their gender identity.
C. A health carrier offering a health benefit plan providing individual or group health insurance coverage shall not deny or limit coverage or impose additional cost sharing or other limitations or restrictions on coverage, under a health benefit plan for health care services that are ordinarily or exclusively available to covered individuals of one sex, to a transgender individual on the basis of the fact that the individual's sex assigned at birth, gender identity, or gender otherwise recorded is different from the one to which such health services are ordinarily or exclusively available.
D. An individual shall not be subjected to discrimination under a health benefit plan on the basis of gender identity or being a transgender individual, including by being denied coverage of medically necessary transition-related care.
E. Nothing in this section is intended to determine, or restrict a health carrier from determining, whether a particular health care service is medically necessary or otherwise meets applicable coverage requirements in any individual case.
F. A health carrier shall not require any individual, as a condition of enrollment or continued enrollment under a health benefit plan, to pay a premium or contribution that is greater than such premium or contribution for a similarly situated covered person enrolled in the plan on the basis of the covered person's gender identity or being a transgender individual.
G. Health carriers shall assess medical necessity according to nondiscriminatory criteria that are consistent with current medical standards.
Last updated Jul 9, 2020.
Washington
Washington has explicit insurance guidance on transgender-related health care.
Statutes:
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Summary:
Sec. 2 “(4) Gender affirming treatment must be covered in a manner compliant with the federal mental health parity and addiction equity act of 2008 and the federal affordable care act. Gender affirming treatment can be prescribed to two spirit, transgender, nonbinary, intersex, and other 36 gender diverse individuals. (5) Nothing in this section may be construed to mandate coverage of a service that is not medically necessary."
Sec. 4 “(2)(a) The authority and any managed care plans delivering or administering services purchased or contracted for by the authority may not apply categorical cosmetic or blanket exclusions to gender affirming treatment. (b) Facial feminization surgeries and facial gender affirming treatment, such as tracheal shaves, hair electrolysis, and other care 30 such as mastectomies, breast reductions, breast implants, or any 31 combination of gender affirming procedures, including revisions to prior treatment, when prescribed as gender affirming treatment, may not be excluded as cosmetic.”
Regulations
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Summary:
(A) “Any health services that are ordinarily or exclusively available to individuals of one sex, based on the fact that an individual's sex assigned at birth, gender identity, or gender otherwise recorded is different from the one to which such health services are ordinarily or exclusively available. For example, a denial of coverage for medically necessary hormone prescriptions for transgender, gender nonconforming, or intersex individuals because the dosages exceed those typically prescribed for cisgender people would be discriminatory against transgender, nonbinary, gender nonconforming, or intersex individuals...”
(vi) "When prescribed as medically necessary, exclude facial gender affirming treatment (such as tracheal shaves), hair removal procedures, and other care (such as mastectomies, breast reductions, breast implants, or any combination of gender affirming procedures, including revisions to prior treatment) as cosmetic services..."
Bulletins and Announcements:
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Guidance: Letter re: Transgender Health Nondiscrimination Protections
Issued by: Insurance Commissioner Mike Kreidler
Issued on: June 23, 2020
Summary:
This letter was sent to insurers in response to the announcement the Trump administration made that it intends to limit the protections transgender patients have under the Affordable Care Act. It was accompanied by a press release.
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Guidance: Letter to Health Insurance Carriers in Washington State
Issued by: Washington Office of Insurance Commissioner
Issued on: June 25, 2014
Summary:
“Reading the provisions of state law in conjunction with the definitions contained in Washington state’s Law Against Discrimination, and the requirements of the federal Affordable Care Act, it is clear that exclusions, prohibitions, and other forms of discrimination by issuers against policy holders who identify as transgender is prohibited.”
Last updated on Mar 6, 2023.
West Virginia
West Virginia has no explicit insurance guidance on transgender-related health care.
Last updated on Feb 23, 2020.
Wisconsin
Wisconsin has explicit insurance guidance on transgender-related health care.
Regulations
Bulletins and Announcements:
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Bulletin: Nondiscrimination regarding Coverage for Insureds Who are Transgender or Gender Dysphoric
Issued by: Wisconsin Insurance Commissioner
Issued on: June 29, 2020
Summary:
To enforce state anti-discrimination laws, the Office of the Commissioner of Insurance (OCI) will not accept policy form filings that contain exclusions or limitations on benefits that are based on a person’s gender identity.
Consumer Complaints:
Any individual who believes they may have faced discrimination on the basis of sex, gender identity, or a gender dysphoria diagnosis may contact the Office of the Commissioner of Insurance to file a complaint.
Last updated Mar 6, 2023.
Wyoming
Wyoming has no explicit insurance guidance on transgender-related health care.
Last updated on Feb 23, 2020.
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