April 29, 2020
DEPARTMENT OF FINANCIAL SERVICES ANNOUNCES FINAL REGULATION TO PREVENT DISCRIMINATION AGAINST TRANSGENDER AND GENDER NON-CONFORMING INDIVIDUALS
Cements Protections of Current Guidance Related to Gender Dysphoria, Coverage for Non-Gender Specific Services and Coverage for PrEP into New York State Law
The New York State Department of Financial Services (DFS) issued a final regulation cementing into New York State Insurance Law current circular letters regarding coverage for gender dysphoria, coverage for non-gender specific services, and coverage for the HIV-prevention preexposure prophylaxis (PrEP).
“This final regulation provides important protections to the New York LGBTQ community, ensuring that they are not denied medically necessary coverage by health insurers based on gender identity, sexual orientation or transgender status,” said Superintendent Lacewell. “DFS will continue to make sure that all New Yorkers have access to healthcare services they need.”
The final regulation prohibits New York State-regulated health insurers from:
- Including a policy clause that purports to deny, limit, or exclude coverage based on an insured’s sexual orientation, gender identity or expression, or transgender status;
- Denying, limiting, or otherwise excluding medically necessary services or treatment otherwise covered by a policy on the basis that the treatment is for gender dysphoria; provided that an insurer shall provide an insured with the utilization review appeal rights required by Insurance Law and Public Health Law Articles 49 for gender dysphoria treatment that is denied based on medical necessity;
- Designating an insured’s sexual orientation, gender identity or expression, or transgender status as a pre-existing condition for the purpose of denying, limiting, or excluding coverage; or
- Denying 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 unless the insurer has taken reasonable steps, including requesting additional information, to determine whether the insured is eligible for the services prior to denial of such claim.
DFS also mandated that New York State-regulated insurers provide coverage without cost-sharing for preventive care and screenings, including coverage for preexposure prophylaxis with effective antiretroviral therapy for people who are at high risk of HIV.
Today’s final regulation follows Governor Andrew M. Cuomo’s announcement directing DFS to propose new regulations to further protect access to health insurance for the LGBTQ community.
DFS carefully considered all comments submitted regarding the regulation during a notice and public comment following publication in the New York State Register.