California has explicit insurance guidance on transgender-related health care.
Statutes:
Prohibits exclusions based on sex, including transgender status.Regulations:
Prohibits insurance coverage limitations based on transgender status.Bulletins and Announcements:
This document assessed the cost associated with adopting regulations that prohibited transgender exclusions. It concluded the regulation would "cost little or nothing in the short run and may produce longer-term cost savings and improved health benefits for transgender people."
Notes that exclusions for medically necessary “gender transition services” are discriminatory and should be removed from all managed care plans.
The purpose of this Notice is to remind California health insurers that the above-referenced federal rule does not preempt state law. Health insurance regulated by the California Department of Insurance (Department) remains subject to California’s antidiscrimination law. Consequently, health insurers must continue to comply with the existing antidiscrimination standards in California law, beyond the minimum requirements of federal law.
California Insurance Commissioner Ricardo Lara, together with 17 state insurance commissioners, announced he is submitting a letter to U.S. Secretary of Health and Human Services, Alex Azar, urging the Trump administration to protect rules addressing unfair treatment of transgender consumers.
Statement in response to the Trump Administration reversing non-discrimination protections under Section 1557 of the Affordable Care Act.
Enforcement Actions:
Consumer Complaints:
You can file a complaint with the California Department of Insurance or the California Department of Managed Care, depending on your type of plan.
Consumer complaints are separate from the appeals process. They are appropriate for things such as unfair discrimination, billing problems, cancellation of coverage, claim and copay disputes, and network adequacy issues.