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Tuesday, 08 November 2016 15:06

Required Changes to Your Transgender Benefits in 2017

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If your company administers a self-funded medical plan, you need to be aware of benefit changes that should be made in 2017 to comply with Section 1557 of the Affordable Care Act. Section 1557 prohibits discrimination on the basis of sex, age, race, color, national origin, and disability. 
 
The regulations were released by the Department of Health and Human Services (HHS), and specific requirements were laid out for health insurance coverage for transgender individuals. 
 
Currently, there is a blanket exclusion in many benefit plans that specifically excludes coverage of gender reassignment surgery and transgender-related services. HHS has determined that this exclusion is discriminatory under Section 1557, and that any health plan receiving funding from HHS needs to remove the broad exclusions. Furthermore, The Equal Employment Opportunity Commission (EEOC) has indicated that self-funded plans are also subject to these obligations under Section 1557. Most self-funded benefit plans currently do not cover transgender-related services and surgery. 
 
Upon a self-funded plan’s renewal date in 2017, action should be taken to remove these blanket benefit exclusions. Plans and carriers may still specify the steps in a clinical path that must be followed in order to qualify for the surgery. In addition to covering gender reassignment surgery in certain circumstances, plans should also cover sex-specific services that accommodate transgender individuals (such as a transgender woman seeking a prostate exam). While not advised, self-funded employers can make the decision to continue excluding transgender services and risk potential discrimination litigation by employees, the HHS, or the EEOC. 
 
Fully insured carriers will be making the required changes on the employer’s behalf and no action is needed. Most self-funded administrators, such as Cigna, have communicated their plan to remove the exclusions with the company’s 2017 renewal date, unless advised otherwise by the employer. Check with your carrier, or contact us to ensure that your self-funded group health plan is compliant with these new regulations! Of course, employers will want to watch for changes coming to the ACA with the new administration, but until the future direction is clear we recommend plans comply in the meantime.
 
Read 2214 times Last modified on Monday, 14 September 2020 19:38
Tonya Young

Tonya is our Senior Account Manager and brings eleven years of prior insurance company expertise to Fall River, having worked at Anthem Blue Cross and Great-West Healthcare (now part of CIGNA). Tonya holds a Bachelor of Science in Psychology from Texas A&M University. Originally from Minnesota, she loves the Colorado outdoors and enjoys family time with her young daughter.