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Healthcare and Transgender: Understanding the Regulations

Over the past year, one of the more prominent topics of discussion in the media has been transgender rights. From bathroom access to healthcare access, this looks to be the next big social issue to be tackled on the national stage. Because healthcare industry standards and legal requirements for this issue are still in flux, it can be hard to know exactly what benefits must be offered and what isn’t allowed. To aid you in sifting through all the rhetoric, here is what is known about transgender healthcare requirements.

1. Insurers must accept preexisting conditions, which includes gender dysphoria.

Gender dysphoria is the condition of one’s gender identity not matching his/her birth gender. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) of the American Psychiatric Association states that this condition is often characterized by “clinically significant distress” or a weakened ability to function in work and social life. The DSM had previously called this “gender identity disorder.” A transgender person is someone with gender dysphoria, whether or not that person suffers distress or impairment.

2. Denial of healthcare based on gender identity is prohibited.

Per the Department of Health and Human Services (HHS), insurers cannot deny a service for the reason of gender identity. Thus, if something like hormone therapy is covered for one group, it cannot be excluded for transgender people. Similarly, sex-specific services, such mammograms, cannot be denied based on a person’s gender identity.

3. Blanket exclusions for gender transition services are prohibited.

Although HHS has yet to define specifics about what exactly must be covered, services included under “gender transition” would likely be such things as hormone therapy, counseling, and possibly surgery.

4. Discrimination based on gender identity is prohibited.

While not technically involved in healthcare, the U.S. Equal Employment Opportunity Commission deals in workplace discrimination and has been involved in a number of lawsuits concerning transgender health issues. As such, denying coverage for services based on gender identity may open up an employer to claims of discrimination and possible lawsuits.

Although specific healthcare coverage details have yet to be determined (such as what exactly has to be covered), enough information exists to give us at least a good indication of what should be offered and what may lead to legal action against if not offered. And considering that the number of lawsuits based on claims of gender discrimination and denial of healthcare seem to be rising, understanding your healthcare responsibilities is crucial.

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