Impact of proposed rule on transgender care unclear for payers

The Obama administration recently proposed a rule that would strengthen protections against gender-identity discrimination. But it's not clear how it will impact the health insurance industry, reports Healthcare Dive.

The proposed rule does not require that health insurers cover gender transition care, including transgender surgery, but it would require insurers to use non-discriminatory criteria in making determinations about coverage, the article says.

The rule, now open to public comment through Nov. 9, would apply to many providers and insurers, including all hospitals that treat Medicare or Medicaid patients and all health plans that offer coverage through the Affordable Care Act's health insurance marketplaces.

It's uncertain at this stage how insurers would address the provision and coverage of transgender care. America's Health Insurance Plans, for instance, has yet to take a position on the proposed rule. And multiple insurers chose not to say whether they see it as cost-effective to provide gender transition coverage, notes the article. 

Some insurers already cover gender transition care, including Aetna and Harvard Pilgrim. Starting in 2009, Aetna was the first major health insurer to add gender reassignment procedures as a benefit for its employees and any contracted companies choosing to add it to their benefits package, Aetna spokesman Walt Cherniak told Healthcare Dive.

Harvard Pilgrim was the first company in the New England region to offer a fully-insured transgender benefit, company spokeswoman Mary Wallen told the publication. For the last two years, it has offered coverage for sexual reassignment and related surgeries to its employees.

The proposed rule would specifically prohibit blanket policies from insurers that ban coverage of gender-transition care and would require individuals to be treated consistent with their gender identities. The Department of Health and Human Services said in the proposed rule that it anticipates that a large number of providers and one-third of health insurers will need to develop or revise policies or procedures to comply.

To learn more:
read the Healthcare Dive article
- here's the proposed rule (.pdf)

Related Articles:
Proposed rule bans transgender discrimination in healthcare
Debate continues whether insurers comply with ACA's transgender-coverage mandate
Feds ban health insurers that have blanket exclusions on gender transition care
More insurers cover gender reassignment surgeries
Transgender patients form their own health referral networks

 

Suggested Articles

A judge has dismissed the ongoing case between Oscar Health and Blue Cross Blue Shield of Florida over broker arrangements.

On-demand doctor house call app Heal is expanding its services into the New York City market with the acquisition of Doctors on Call.

Expanding options for dental care in Medicare is a popular idea, but policymakers could take several avenues toward this goal, a new analysis shows.