Insurance Commission Bulletin IC-37: GENDER IDENTITY NONDISCRIMINATION REQUIREMENTS

The actual bulletin from the Insurance Commission is here.

It reads in part,

Categories of Health Insurance: As described above, discrimination in handling of claims for medically necessary treatment of gender dysphoria is prohibited. This prohibition extends to the categories of health insurance covered under sections 38a-488a [Individual and Group Mental Health Parity Statute - individual health insurance] and 38a-514 [Individual and Group Mental Health Parity Statute - group health insurance ] of the Connecticut General Statutes, specifically categories (1), 2), (4), (11) and (12) under section 38a-469 of the Connecticut General Statutes. These categories are basic hospital expense coverage, basic medical-surgical expense coverage, major medical expense coverage, hospital or medical service plan contract coverage and hospital and medical coverage provided to health care center members. For other categories of health insurance included under section 38a-469 of the Connecticut General Statutes, including but not limited to, hospital indemnity, disability income, accident only and specified disease and specified accident coverage, there is no contractual commitment to pay for medically necessary care. However, based on Public Act 11-55, licensed entities are prohibited from using an exclusion based solely on gender identity or expression, including an exclusion for gender reassignment and related services, or otherwise discriminating against insured individuals with gender dysphoria

There is an important note at the end of the bulletin...

Important Note: Although a blanket policy exclusion for gender transition and related services is prohibited, a health insurer, HMO or other entity, with respect to the coverages subject to sections 38a-488a [Individual and Group Mental Health Parity Statute - individual health insurance] and 38a-514 [Individual and Group Mental Health Parity Statute - group health insurance ] of the Connecticut General Statutes, may still perform medical necessity determinations on a case by case basis with respect to an insured's request for transgender services. However, if the request is denied on the basis the services are not medically necessary, the insured has the right to an independent review through the Department's External Review Program.

CT Insurance Commissioner Requires Coverage For Us.

Connecticut joins California, Colorado, Oregon, Vermont and the District of Columbia to require health insurance coverage gender dysphoria. That means that gender confirming surgery, hormones and other expenses related to transition and health care will be covered.

State Requiring Heath Insurers To Cover Gender Transition
Hartford Courant
By DANIELA ALTIMARI
December 26, 2013

HARTFORD – The Connecticut Insurance Department is directing all health insurance companies operating in the state to provide coverage of mental health counseling, hormone therapy, surgery and other treatments related to a patient's gender transition.

Joining a handful of other states, the department issued a bulletin to insurance companies last week which seeks to ensure that "individuals with gender dysphoria … are not denied access to medically necessary care because of the individual's gender identity or gender expression."

Deputy insurance Commissioner Anne Melissa Dowling said the state wanted to "go out and affirmatively make [the policy] very clear."

"As we were turning the corner into the new year, we just wanted to make sure every constituency was clearly heard,'' she said.

If you are insured by a Connecticut company you now get all your medical expenses covered, including hormones and Gender Conforming Surgery. However, if you employer is an ERISA (Employee Retirement Insurance and Security Act) then you may not be covered because they are under federal law, not state law. From what we understand if you have Medicaid we believe that you also would be covered, but not if you are covered by Medicare because Medicaid is a state plan while Medicare is a federal plan.