[News/Health] [NH, USA] More state workers entitled to coverage for sex-change surgery following governor's executive order
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Stephanie Stevens
Oct 21, 2016, 10:06:06 AM10/21/16
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Manchester Union Leader, NH, USA
October 20. 2016 8:47PM
More state workers entitled to coverage for sex-change surgery following governor's executive order
By MARK HAYWARD
New Hampshire Union Leader
Workers and retirees covered under the New Hampshire state employee health care plan have had access to gender reassignment surgery since July 1, shortly after Gov. Maggie Hassan issued an executive order forbidding discrimination on the basis of gender identity, a top state official said this week.
The surgery became available ahead of a Jan. 1 deadline established by federal regulations, said Administrative Services Commissioner Vickie Quiram. She said the decision to provide early coverage was based upon Hassan’s executive order and Anthem Blue Cross, the company that administers the state’s health plan.
Anthem will include gender reassignment surgery in all its health plans starting Jan. 1.
“Just like any other health care, it would have to be medically necessary,” said Quiram, noting that medical necessity would be determined on a case-by-case basis by Anthem Blue Cross.
The state had previously excluded gender transition surgery from its health plan.
But as some employers rush to include gender reassignment surgery in their health plans, indications are that the coverage may not be mandated under federal regulations adopted in May.
New Hampshire Insurance Department spokesman Danielle Barrick said in an email that a blanket exclusion of gender transition coverage is prohibited in the new regulation. But the new regulations do not require that all services, for example, certain surgeries specific to gender transition, be provided, she said.
The regulations spell out compliance with a section of the Affordable Care Act, which prohibit discrimination, and address health care issues related to gender.
Anthem Blue Cross believes the company must provide gender reassignment surgery when medically necessary, said Anthem spokesman Colin Manning. The company will start providing coverage in all fully insured plans starting Jan. 1, or upon the 2017 renewal date of existing policies, Manning said.
“We think there will be very few claims,” Manning said.
The company also advised its self-funded clients, such as state government and Manchester, to consult with their lawyers.
Wording of the regulation is far from clear.
The regulations prohibit a “categorical coverage exclusion or limitation for all health services related to gender transition.”
“The Nondiscrimination Rule prohibits the companies from categorically excluding all care related to gender transition, but it does not require that any particular services be covered,” Barrick said.
An explanation on Healthcare.gov says only that transgender health insurance exclusions “may be unlawful sex discrimination.”
And the self-described independent, grassroots website ObamaCare Facts said the new rules “fell just short of requiring health plans to pay for gender transition.”
In other areas, the rules give specificity. For example, an insurance company cannot deny a transgendered person a sex-specific treatment or procedure because of the gender the person identifies with.
“For example, a provider may not deny an individual treatment for ovarian cancer, based on the individual’s identification as a transgender man, where the treatment is medically indicated,” reads an explanation on HHS.gov.
Meanwhile, the attorney general for Texas has sued the federal government, challenging the rule. Filing suit on behalf of Texas and four other states, Ken Paxton said the regulation forces doctors to perform procedures that are contrary to a doctor’s medical judgment.
“The federal government has no right to force Texans to pay for medical procedures designed to change a person’s sex,” Paxton said in a news release.
It is the 13th suit Paxton has filed challenging provisions of the ACA.
http://www.unionleader.com/health/more-state-workers-entitled-to-coverage-for-sex-change-surgery-following-governors-executive-order-20161021
October 20. 2016 8:47PM
More state workers entitled to coverage for sex-change surgery following governor's executive order
By MARK HAYWARD
New Hampshire Union Leader
Workers and retirees covered under the New Hampshire state employee health care plan have had access to gender reassignment surgery since July 1, shortly after Gov. Maggie Hassan issued an executive order forbidding discrimination on the basis of gender identity, a top state official said this week.
The surgery became available ahead of a Jan. 1 deadline established by federal regulations, said Administrative Services Commissioner Vickie Quiram. She said the decision to provide early coverage was based upon Hassan’s executive order and Anthem Blue Cross, the company that administers the state’s health plan.
Anthem will include gender reassignment surgery in all its health plans starting Jan. 1.
“Just like any other health care, it would have to be medically necessary,” said Quiram, noting that medical necessity would be determined on a case-by-case basis by Anthem Blue Cross.
The state had previously excluded gender transition surgery from its health plan.
But as some employers rush to include gender reassignment surgery in their health plans, indications are that the coverage may not be mandated under federal regulations adopted in May.
New Hampshire Insurance Department spokesman Danielle Barrick said in an email that a blanket exclusion of gender transition coverage is prohibited in the new regulation. But the new regulations do not require that all services, for example, certain surgeries specific to gender transition, be provided, she said.
The regulations spell out compliance with a section of the Affordable Care Act, which prohibit discrimination, and address health care issues related to gender.
Anthem Blue Cross believes the company must provide gender reassignment surgery when medically necessary, said Anthem spokesman Colin Manning. The company will start providing coverage in all fully insured plans starting Jan. 1, or upon the 2017 renewal date of existing policies, Manning said.
“We think there will be very few claims,” Manning said.
The company also advised its self-funded clients, such as state government and Manchester, to consult with their lawyers.
Wording of the regulation is far from clear.
The regulations prohibit a “categorical coverage exclusion or limitation for all health services related to gender transition.”
“The Nondiscrimination Rule prohibits the companies from categorically excluding all care related to gender transition, but it does not require that any particular services be covered,” Barrick said.
An explanation on Healthcare.gov says only that transgender health insurance exclusions “may be unlawful sex discrimination.”
And the self-described independent, grassroots website ObamaCare Facts said the new rules “fell just short of requiring health plans to pay for gender transition.”
In other areas, the rules give specificity. For example, an insurance company cannot deny a transgendered person a sex-specific treatment or procedure because of the gender the person identifies with.
“For example, a provider may not deny an individual treatment for ovarian cancer, based on the individual’s identification as a transgender man, where the treatment is medically indicated,” reads an explanation on HHS.gov.
Meanwhile, the attorney general for Texas has sued the federal government, challenging the rule. Filing suit on behalf of Texas and four other states, Ken Paxton said the regulation forces doctors to perform procedures that are contrary to a doctor’s medical judgment.
“The federal government has no right to force Texans to pay for medical procedures designed to change a person’s sex,” Paxton said in a news release.
It is the 13th suit Paxton has filed challenging provisions of the ACA.
http://www.unionleader.com/health/more-state-workers-entitled-to-coverage-for-sex-change-surgery-following-governors-executive-order-20161021
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