Guidance reminds health insurers they cannot deny coverage based on gender identity

The New York Department of Financial Services (DFS) has sent a circular letter to health insurers in New York stressing that they cannot discriminate or deny coverage based on gender identity. New York Governor Cuomo said the action is aimed at making sure that transgender and gender-nonconforming individuals receive coverage regardless of whether they present as the gender to whom the service is typically or exclusively provided. The letter instructs health insurers to take reasonable steps, including requesting additional information, to determine whether the insured is eligible for the services prior to denying a claim.
The letter came after reports received by DFS that some health insurance companies may be denying claims of transgender individuals because the gender with which the individual identifies does not match the gender of someone to whom those services are typically provided. A person who was assigned female at birth, but presents as male, may be denied a claim for cervical cytology screening, for example, because the health insurer’s information indicates the insured is male.
The DFS guidance reminds health insurers that, although a health insurer may request additional information regarding a specific medical service, a health insurer is prohibited from denying a claim because it lacks sufficient information to pay the claim. Where a health insurer receives a claim from an insured of one gender or sex for a service that is typically or exclusively provided to an individual of another gender or sex, the insurer should take reasonable steps, including requesting additional information, to determine whether the insured is eligible for the services prior to denying the claim.
Moreover, when processing claims for health services provided to transgender or gender nonconforming individuals, health insurers may not deny or limit health services, which 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 is different from the one to which such health services are ordinarily or exclusively available.
“In New York, we believe that health care is a right, and we are committed to protecting that right for all New Yorkers, regardless of income, age, race, sexuality or gender identity,” Governor Cuomo said in a release. “Now, more than ever, we are leading the nation in furthering protections to all New Yorkers that those in Washington seek to eliminate, and we will continue to work to combat discrimination in all forms and ensure equal treatment for all.”

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