Governor Cuomo Takes Decisive Action to Ensure Insurance Coverage for Transgender and Gender Nonconforming Individuals
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Financial Services Superintendent
The circular letter follows reports received by DFS that some health insurance companies may be denying claims of transgender individuals because the gender with which the individual identifies does not match the gender of someone to whom those services are typically provided. For example, a person who was assigned female at birth but presents as male may be denied a claim for cervical cytology screening because the health insurer's information indicates that the insured is male. Similarly, a person who was assigned male at birth but presents as female may be denied a claim for prostate cancer screening because the health insurer's information indicates that the insured is anatomically a female.
The DFS guidance reminds health insurers that, although a health insurer may request additional information regarding a specific medical service, a health insurer cannot deny a claim because it does not have sufficient information to pay the claim. A health insurer who receives a claim from an insured of one gender or sex for a service that is typically or exclusively provided to an individual of another gender or sex should take reasonable steps, including requesting additional information, to determine whether the insured is eligible for the services prior to denying the claim.
Additionally, when processing claims for health services provided to transgender or gender nonconforming individuals, health insurers may not deny or limit health services that are ordinarily or exclusively available to individuals of one sex, to a transgender individual based on the fact that the individual's sex assigned at birth, gender identity, or gender is different from the one to which such health services are ordinarily or exclusively available.
This action complements a series of actions by
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