Transgender Anti-Discrimination Rule

The U.S. Department of Health and Human Services has finalized a rule in the Affordable Care Act (ACA) that “bans discrimination against transgender people throughout the healthcare system” and will force many employers to cover transgender medical services. A recent article in Modern Healthcare, HHS Finalizes Transgender Anti-Discrimination Rule, explains the entire ruling in layman’s terms (final ruling can be found here). Essentially, any employer not complying with this new rule will no longer be eligible for federal funding they are, or may be in the future, receiving.

While N.Y.S. has mandated these types of services since 2014 in all fully insured plans, self-funded health plans were not required to comply with the mandate. Reasons for not including these types of services range from religious beliefs to cost containment strategies. Transgender surgery is often quite expensive. Self-funded employers often avoid covering these types of services simply to keep their health care expenditures in check.

The rule is effective as of a plans 1st renewal after January 1, 2017. Therefore, it will be necessary for all self-funded plans to update their benefit plans at the time of renewal and notify their employees of the change(s). If you would like more information on this mandate, or would like to evaluate the financial impact it will have on your plan, please don’t hesitate to reach out for assistance.