California Insurance Coverage

California insurance companies must end exclusions of medically-necessary care for transgender people...

Ore., Calif., require transgender health coverage
Huffington Post (AP)
JONATHAN J. COOPER
January 11, 2013

SALEM, Ore. — Regulators in Oregon and California have quietly directed some health insurance companies to stop denying coverage for transgender patients because of their gender identity.

The states aren't requiring coverage of specific medical treatments. But they told some private insurance companies they must pay for a transgender person's hormone therapy, breast reduction, cancer screening or any other procedure deemed medically necessary if they cover it for patients who aren't transgender.

The changes apply to companies insuring about a third of Oregonians and about 7 percent of Californians, but not to people on Medicare and Medicaid or to the majority of Californians who are insured through a health management organization, or HMO.

As the article says, this does not require to cover GCS (Gender Conforming Surgery) but only requires the insurance company to cover what they offer other medically necessary treatments. For an example, if insurance pays for medically necessary Orchiectomy, Penectomy, Vaginoplasty, Clitoroplasty or Labiaplasty for non-transgender patients then they must cover trans-patients.

See also our blog post on the Oregon bulletin.