FAQ on the Insurance Division Announcement

Frequently Asked Questions on the Insurance Division Announcement

Overview

The Oregon Department of Business and Consumer Services (DCBS) has released a bulletin announcing that in order to comply with current statutes prohibiting gender discrimination, health insurance plans sold in Oregon can no longer deny care to transgender policy holders which is provided to non-transgender (or “cisgender”) policy holders. Removing these outdated exclusions brings Oregon up-to-date with the latest information from medical experts and will provide countless Oregonians with access to medically necessary health care. To read the bulletin, please click here: http://www.cbs.state.or.us/ins/bulletins/bulletin2012-01.html

 

WHAT is DCBS and what authority does it have?

DCBS oversees health insurance regulations in the state of Oregon. Because insurance companies must comply with DCBS regulations in order to sell insurance in the state, a bulletin from DCBS carries the force of law in Oregon. If your insurance is provided by your employer, please note that many larger businesses are based out of state and are governed by federal laws, like ERISA, that preempt state level nondiscrimination protections. These businesses likely buy their insurance in another state and will be unaffected by this bulletin. Businesses that are self-insured may also be exempt from this bulletin. For more information on advocating for trans-inclusive healthcare in your workplace, download our one-of-a-kind toolkit.

 

What kinds of exclusions does the decision impact?

The bulletin specifically states that:

• Health insurers must provide coverage and cannot deny coverage of treatments for transgender policy holders if the same treatments are covered for other policy holders. If an insurer covers breast reduction surgery to lessen back pain, the insurer could not deny breast reduction surgery for gender transition if the provider deemed the treatment medically necessary. If hormone therapy is covered for other policyholders, it cannot be denied for gender transition if determined to be medically necessary. On the other hand, an insurer could exclude all coverage of breast implants or penile implants. In short, Oregon law requires equality in treatment.
• Health insurers may not have riders that categorically exclude all transgender patients.
• The statewide mandate for coverage of mental health services must apply to transgender patients.
• The designation of male or female may not be relevant to treatment (ie, a person cannot be denied an ovarian cancer screening on the basis that they identify as male).

 

WHY IS THIS DECISION NEEDED?

Insurance companies routinely refuse to provide insurance to transgender people based on their transgender status or specifically exclude transgender-related services. Nearly all insurance plans categorically excluded coverage for transgender-related medical treatment, even when that treatment (such as mental health care or hormone replacement therapy) is covered for non-transgender people. 

Is this necessary medical care?

Our nation’s most reputable medical bodies have identified transgender health care as being medically necessary. In 2008, the American Medical Association passed a resolution supporting public and private health insurance coverage for treatment of gender identity disorder and opposing the “exclusions of coverage for treatment of gender identity disorder when prescribed by a physician.” That same year, the American Psychological Association passed a resolution stating that the organization “opposes all public and private discrimination on the basis of actual or perceived gender identity and expression and urges the repeal of discriminatory laws and policies;. And in 2012 the American Psychiatric Association affirmed that the organization “Urges the repeal of laws and policies that discriminate against transgender and gender variant individuals.” and “Opposes all public and private discrimination against transgender and gender variant individuals in such areas as health care, employment, housing, public accommodation, education, and licensing.”

 

WILL THIS RAISE INSURANCE RATES?

Past experience offers helpful information here. In 2010, Multnomah County removed exclusions from their employee health plan and in 2011 the City of Portland followed suit. Both municipalities have seen no significant cost impact to their health plan. For example, the City of Portland estimated the premium impact to be .08%. The City and County of San Francisco removed exclusions from their employee benefits plan in 2001 and have not seen any discernible increase in health care costs.

 

HOW WILL THIS AFFECT MEDICARE AND MEDICAID?

Because Medicare and Medicaid (Oregon Health Plan) are federally funded, it is unclear if this bulletin will apply. What is clear is that the ruling will apply to all private insurance companies that operate in Oregon. Basic Rights Oregon and transgender community leaders will continue working together to increase access to medically necessary care for all Oregonians.

 

HOW DOES THIS DECISION IMPACT HEALTH REFORM?

Under the Affordable Care Act, each state decides what is included in their health plans. This decision means that insurance companies participating in Oregon’s health exchange will need to comply with the bulletin.

 

WHO ELSE IS PROVIDING THIS COVERAGE AND WHY?

Currently, 25% of Fortune 100 Companies and many Oregon businesses, both large and small, offer inclusive health care, including healthcare for transgender employees.  These businesses believe that providing all employees with the medically-necessary care they need to be healthy and productive is not just good for employees and their families, they know it is good for business.

 

Oregon businesses that offer transgender-related coverage to their employees include:Oregon Health and Sciences University (OHSU), New Seasons, the National College of Natural Medicine, Portland State University, Progressive Insurance,  Starbucks, Alcatel-Lucent, American Express, Ameriprise Financial, AT&T, Bank of America, Chrysler Motors, IBM, Kimpton Hotel & Restaurant Group, KPMG, Kraft Foods, McGraw-Hill, Microsoft, and State Farm.

 

WHAT DO I DO IF I THINK AN INSURER HAS UNFAIRLY DENIED MY CLAIM

You  must file an appeal through the insurance provider, after which an individual may appeal to an imparital medical panel for an external review.  You may receive help with your complaint from an insurance consumer advocate by calling 1-888-877-4894 or by going clicking or going online to this website: http://www.cbs.state.or.us/ins/consumer/tomake.html

Click here to download the  frequently asked questions regarding the recent bulletin from the Insurance Division.

To read the bulletin in its entirety, please click here.

 

For more information, contact Basic Rights Oregon at 503-222-6151 or email tash@basicrights.org.

Category: Resources: Transgender Justice