Payers participating in health insurance marketplaces or receiving funding through plans including Medicare parts A, B and D are banned from discriminating against protected classes including transgender individuals under a final rule from the Department of Health and Human Services' Office for Civil Rights.
Under the rule, individuals are protected from discrimination in healthcare on the basis of race, color, national origin, age, disability and sex, including discrimination based on pregnancy, gender identity and sex stereotyping.
"The protections in the final rule and Section 1557 regarding individuals' rights and the responsibilities of many health insurers, hospitals and health plans administered by or receiving federal funds from HHS build on existing federal civil rights laws to advance protections for underserved, underinsured and often excluded populations," notes an HHS announcement.
The rule goes into effect July 18, but the provisions affecting insurers and the design of health plan benefits are effective Jan. 1, 2017. The plan was proposed in September 2015.
The antidiscrimination rule covers payers' individual market business both in and outside the insurance marketplace, the group market and when serving as a third-party administrator for a self-insured group plan. It includes excepted benefits even though those benefits are not otherwise regulated by the Affordable Care Act.
Although health payers can market to protected classes, they cannot exclude protected classes in their marketing efforts, according to HHS.
According to an HHS fact sheet, under Section 1557 of the ACA, payers can't take the following actions on the basis of race, color, national origin, sex, age or disability:
- Deny, cancel, limit or refuse to issue or renew a health-related insurance plan or other health-related coverage
- Deny or limit a claim or impose additional cost-sharing or other limitations or restrictions on coverage
- Engage in discriminatory marketing practices or adopt or implement discriminatory benefit designs in health-related insurance or other health-related coverage
- Deny or limit coverage of a claim or impose additional cost-sharing or other limitations or restrictions on coverage for sex-specific health services on the basis of gender identification
- Categorically exclude coverage for all health services related to gender transition or deny or limit coverage or impose additional cost-sharing or other limitations or restrictions on coverage for specific health services related to gender transition if doing so results in discrimination against a transgender individual