Governor Andrew Cuomo today
announced health insurers cannot discriminate or deny coverage based on gender
identity. This action will ensure that transgender or gender nonconforming
individuals receive coverage regardless of whether they present as the gender
to whom the service is typically or exclusively provided. A Department of
Financial Services circular letter issued today 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. This announcement builds upon Governor Cuomo's comprehensive actions to
support health insurance access for all New Yorkers, including previous guidance
instructing insurers that they may not deny medically necessary treatment for
gender dysphoria.
"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.
"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."
Financial
Services Superintendent Maria T. Vullo said, "Transgender persons
should not be discriminated against and denied health insurance coverage
because of their transgender status nor denied treatment simply due to
insurance coding issues. DFS will ensure that all New Yorkers, regardless of
gender identity, receive the health insurance coverage they need."
The circular letter follows
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. For example, a person who was assigned female at
birth but presents as male may be denied a claim for cervical cytology
screening because the health insurer's information indicates that the insured
is male. Similarly, a person who was assigned male at birth but presents
as female may be denied a claim for prostate cancer screening because the
health insurer's information indicates that the insured is anatomically a
female.
The DFS guidance reminds
health insurers that, although a health insurer may request additional
information regarding a specific medical service, a health insurer cannot deny
a claim because it does not have sufficient information to pay the claim.
A health insurer who 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 should take reasonable steps, including requesting additional
information, to determine whether the insured is eligible for the services
prior to denying the claim.
Additionally, when
processing claims for health services provided to transgender or gender
nonconforming individuals, health insurers may not deny or limit 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 is different from the one to
which such health services are ordinarily or exclusively available.
This action compliments a
series of actions by Governor Cuomo to protect health insurance coverage for
all New Yorkers regardless of federal actions. In June, Governor Cuomo directed DFS to
promulgate new emergency regulations mandating health insurance providers do
not discriminate against New Yorkers with preexisting conditions or based on
age or gender, in addition to safeguarding the 10 categories of essential
health benefits guaranteed by the ACA.
Source: Press Office, Governor Andrew M.
Cuomo
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