In a July Independence Edge article, we shared that the U.S. Department of Health and Human Services (HHS) had issued a final rule for the nondiscrimination provision (section 1557) of the Affordable Care Act (ACA). While the nondiscrimination provision itself is not new, the final rule provides expanded clarity on coverage for gender reassignment surgery and related services. In addition, it provides guidance on treating individuals consistent with their gender identity, and not denying or limiting health services usually only available to individuals of one gender.
Beginning with renewals on or after January 1, 2017, the exclusion for gender reassignment surgery has been removed from all commercial plans. Members will have access to coverage for gender reassignment surgeries and related services without annual or lifetime dollar limits; coverage will be based on medical necessity and in accordance with all medical policies.
• Gender references have been removed from applicable systems and communications, such as Explanations of Benefits and precertification letters.
• Medical policies have been updated to reflect the change in coverage. An informational draft of the revised medical policy is available. The final version of medical policy will be available on ibx.com as of Nov. 1, 2016.The change in coverage will be communicated to groups and members as part of the annual benefit language clarification mailing in November.
Please contact your Total Benefit Solutions account manager at (215)355-2121 if you have any questions or concerns.