Q: Does this mean plans are required to cover gender reassignment surgery?
A:Section 1557 does not mandate any coverage of benefits, but prohibits discriminatory exclusions or limitations from being placed on benefits. Groups may not exclude gender reassignment surgery (or other benefits) based on a discriminatory factor. This means that a group health plan may exclude or limit gender reassignment surgery (or any other benefit) based on neutral, non-discriminatory factors, such as clinical criteria; however, a group health plan may not exclude or limit gender transition surgery (or any other benefit) because of a discriminatory factor (i.e., age, gender, gender identity, sexual orientation, disability, etc.).
Our insured plans will cover gender reassignment surgery when medically necessary.
- Example 1: Acme chooses to not cover gender reassignment surgery because the owner does not want to employ transgendered persons. Such an exclusion would likely violate 1557, as it is based on a discriminatory factor.
- Example 2: Acme chooses to cover gender reassignment surgery, subject to medical necessity and other clinical criteria. Such a limitation may be permissible under 1557, provided those criteria are neutral and non-discriminatory.
