Transgender exclusions
Written into many health insurance policies are limitations, exceptions, exclusions and reductions for any health care services that might be associated with a person who had transitioned or were transitioning to the opposite sex.
Previous Blue Shield language
For transgender or gender dysphoria conditions, including but not limited to, intersex surgery (transsexual operations), or any related services, or any resulting medical complications, except for treatment of medical complications that is medically necessary.
The new Blue Shield endorsement or exclusion will read:
For Services related to gender transition unless the requested Services would otherwise be covered when not related to gender transition.
Life happens
Not all medical conditions that a person may experience during transition are related to the transition process. But it was easy for an insurance company to deny a claim for an X-ray, office visit or prescription for an illness unrelated to the transition because the person was undergoing the transition. So, if you twist your ankle while playing soccer while you happen to be in transition, health care services to treat the twisted ankle should not be denied. Blue Shield of California will be mailing the endorsement to members the week of April 22, 2013.
Gender Non-Discrimination
Agent update on Blue Shield transgender non-discrimination language sent via email. December 22, 2013
Earlier this year, in response to a California Department of Insurance (CDI) regulation, we sent a notice to your clients enrolled in our Blue Shield of California Life & Health Insurance Company plans. The notice included an endorsement to their Certificate of Insurance, effective September 2012. At that time we were awaiting Department of Managed Health Care (DMHC) guidance.
CDI and DMHC are two different regulatory bodies. DMHC regulates our Blue Shield of California plans and CDI regulates our Blue Shield of California Life & Health Insurance Company plans.
We have now received guidance from DMHC regarding gender non-discrimination in health insurance underwriting and benefit administration. Blue Shield will be updating the Evidence of Coverage for our DMHC plans to reflect this gender non-discrimination guidance, effective January 2014.
How has the gender non-discrimination guidance been implemented?
Blue Shield implemented changes for both CDI- and DMHC-regulated plans to ensure that there are no gender-based exclusions or limitations in our benefits; including exclusions based on gender expression, gender identity or transgender status. Blue Shield also reviewed underwriting procedures to ensure there is no gender discrimination in the way policies are issued or the way premiums are set.
How will this update affect my clients?
Coverage under Blue Shield Plans is not gender based. For example, preventive care services are available, when appropriate, regardless of enrolled gender. Coverage also includes services related to gender transition when the requested services meet Blue Shield’s medical necessity criteria.
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