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Insurers can’t deny gender transition treatment under U.S. plan

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(Bloomberg) — Transgender individuals would gain new health care protections in rules proposed today by U.S. regulators.

See also: LGBT community eyes PPACA’s anti-discrimination provision

Under the rules, discrimination against transgender people would be a form of sex discrimination. That would block insurers from categorically denying coverage for treatments that help people transition to another gender, according to a fact sheet released today by the Department of Health and Human Services (HHS). Some exclusions for transition treatments will be evaluated case-by-case, the agency said.

“Individuals cannot be denied health care or health coverage based on their sex, including their gender identity,” the agency said. “Explicit categorical exclusions in coverage for all health care services related to gender transition are facially discriminatory.”

The rules would apply to insurers and health care providers that get funding from HHS. That includes insurers that participate in government-run marketplaces or sell Medicare Advantage plans, and the rules would also apply to those insurers’ private-employer plans.

The proposal is open to public comment until Nov. 6. The rules build on a portion of the Patient Protection and Affordable Care Act (PPACA) that prohibits discrimination in health care programs.

See also: Lawmakers push for PPACA antidiscrimination regulations

“This rule does not require that any particular services be provided,” said Jocelyn Samuels, director of the health department’s Office for Civil Rights, on a conference call with reporters. “It does require that insurers apply non-discriminatory criteria to assessing the services that they will cover.”

The government said insurers also can’t restrict services based on gender identity. For instance, insurers would still be required to pay for a medically necessary ovarian cancer treatment for someone who identifies as a man, HHS said.

The rules also require health care providers to take more steps to communicate with people who don’t speak English or who have disabilities. And they prohibit marketing practices in health care public exchange programs and insurance benefit designs that are discriminatory.


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