By "healthcare", of course, we use the modern definition: insurance coverage.
The Oregon Insurance Division of the Department of Consumer and Business Services issued a bulletin last month adding transgender people to the list of those who may not be discriminated against.
In 2007 the Oregon state legislature passed a law (SB 2) prohibiting discrimination on the basis of sexual orientation or gender identity. This new measure restricts insurance companies from denying medical and health care coverage to transpeople as laid out by SB 2.
And it only took 5 years to do that.
The bulletin declares six principles that will be applied in regards to the transaction of insurance related to gender identity.
1. An insurer may not discriminate on the basis of an insured's or prospective insured's actual or perceived gender identity, or on the basis that the insured or prospective insured is a transgender person.
Any of the following would constitute discrimination:
a. Denial, cancellation, limitation or refusal to issue an insurance policy on the basis if an insured's or prospective insured's actual or perceived gender identity.
b. Demand or requirement of a payment or premium that is based in whole or in part on an insured's or prospective insured's actual or perceived gender identity.
c. Designation of gender identity or gender dysphoria as a pre-existing condition for which coverage will be denied or limited.
d. Exclusion of all "gender identity disorders."
2. A health insurer may not deny or limit coverage or deny a claim for a procedure provided for GI/GD if the same procedure is allowed in the treatment of another non-GI/GD-related condition.
If the treatment consists of a service provided for the treatment of other conditions or illnesses such as hormone therapy, hysterectomy, mastectomy or vocal training, and the treatment was deemed medically necessary, then the insurer could not deny coverage because in this instance it was for gender transition or treatment of GI/GD.
3. Although a health insurer may categorically exclude coverage for a particular condition or treatment, the insurer may not base such exclusion on gender identity.
The division does not address the determination of medical necessity in this bulletin. However, the division does note that a number of medical professional organizations have addressed the issue. See, “Health Care for Transgender Individuals,” Committee Opinion of the Committee on Health Care for Underserved Women, The American College of Obstetricians and Gynecologists, December 2011; Resolution #114, American Medical
Association House of Delegates, “Removing Barriers to Care for Transgender Patients,” Received 04/14/08; “Position Statement on Access to Care for Transgender and Gender Variant Individuals,” Official Position of the American Psychiatric Association, approved May 2012; “APA Policy Statement: Transgender, Gender Identity & Gender Expression Nondiscrimination,” adopted by the American Psychological Association Council of Representatives, August 2008.
An insurer may categorically exclude treatment of sexual disorders or dysfunctions, but the exclusion must apply across the board. The insurer cannot exclude only sexual disorders or dysfunctions if they are related to GI/GD. This ability to exclude obviously does not allow exclusion of any service or treatment mandated by the Legislative Assembly such as mandates related to mammograms, pelvic examinations, Pap smear examinations, breast exams and mastectomy-related services if those treatments were connected to a sexual disorder or dysfunction.
4. The mandated coverage for mental health services must include mental health counseling and treatment related to GI/GD.
With the passage of SB 2, the division must interpret OAR 836-053-1404 to require mental health treatment of GI/GD identified under Diagnostic codes 302.85, 302.6 or 302.9 for all ages. To deny coverage under those codes would clearly be discrimination based solely on gender identity and thus prohibited under SB 2.
5. The perceived gender identity of a person should not prevent appropriate
Any health care services that are ordinarily or exclusively available to individuals of one sex may not be denied based on the perceived gender identity of a person when the denial or limitation is due only to the fact that the insured is enrolled as belonging to the other sex or has undergone, or is in the process of undergoing, gender transition.
6. The Insurance Division expects insurers’ forms to comply with the policy
expressed in SB 2 as it is incorporated into insurance regulation with this bulletin.
For example, the division will not allow an insurer to include provisions in contracts that violate the SB 2 policy.
This bulletin follows on the heals of notice that the Oregon Health and Science University will begin to provide access to gender transition medical care to all employees. OHSU is the largest employer in Portland, OR. In offering this service OHSU will join the City of Portland, Multnomah County, Intel, and New Seasons Market.
One of OHSU's core missions is to be a diverse organization that nurtures a community of inclusion.
Expanding services to include transgender benefits affirms our commitment to further enhancing a diverse and inclusive environment at OHSU.
--Norwood Knight-Richardson, OHSU senior vice president and chief administrative officer
I am grateful for OHSU's leadership in removing barriers to medically necessary care.
This will make a real difference in the lives of OHSU's transgender employees and underscores the institution's commitment to improving health for all Oregonians.
--Jeana Frazzini, executive director of Basic Rights Oregon