A December 19 bulletin from the State of Connecticut's Insurance Department prohibits health insurers in that state from implementing a blanket policy denying transition-related health care. Insurers will only be able to evaluate medical necessity of any given treatment on case by case bases.
This makes Connecticut the fifth state to require providers to cover treatments related to gender transition, after California, Colorado, Oregon, and Vermont.
[Connecticut] wanted to go out and affirmatively make [the policy] very clear.
As we were turning the corner into the new year, we just wanted to make sure every constituency was clearly heard.
--Deputy Insurance Commissioner Anne Melissa Dowling
The department cited a 2011 statute that added "gender identity or expression" to the state's antidiscrimination law concerning employment, public accommodations, housing, credit, public schools, and other areas…including health care…in extending the equality to health insurance practices. The bulletin states that "medically necessary services related to gender dysphoria should not be handled differently from medically necessary services for other medical and behavioral health conditions."
In many states, health insurance providers and employers can determine whether they wish to include coverage for things like hormone replacement therapy and gender-confirming surgeries. This has typically been seen as a cost-saving maneuver for insurers, but recent studies dispute the actual savings brought on by excluding transition-related coverage.
A Williams Institute study from last September found that among employers with 1000 to 10,000 employees, only one out of 10,000 employees will take advantage of transition-related benefits when they are available. In organizations with 10,000 to 50,000 employees, the expected rate is one in 20,000.
The lifetime cost of an employee going through treatment typically ranges from $25000 to $75000. Thus the actual cost of transition-specific coverage is minimal in comparison to more frequently utilized procedures which are routinely covered.
Consistent with sections 38a-488a and 38a-514 of the Connecticut General Statutes and Public Act 11-55, the Department finds a refusal by an insurer to pay for medically necessary treatment of gender dysphoria to be to be an unfair claim settlement practice under section 38a-816(6) of the Connecticut General Statutes.