OLYMPIA — A rule to shore up access to gender-affirming health care in Washington state is set to go into effect January 1, 2022. Washington Insurance Commissioner Mike Kreidler passed the rule November 30, 2021 , which incorporates the Gender Affirming Treatment Act into state law. (SB 5313), passed by the Washington State Legislature in 2021.
The rule clarifies several aspects of existing law to ensure that medically necessary gender affirmation treatments are covered by health insurers. The wording of the rule previously allowed insurers to deny coverage in a way that subverted the intent of the law.
For example, insurers cannot deny gender-affirming hormone treatments because they are prescribed at different levels than they are for cisgender patients whose gender identity matches their sex assigned at birth.
“While the rule clarifications seem technical, the implications for transgender and gender-diverse people are significant,” said Kreidler. “Advocates have repeatedly told us that gender-affirming treatment saves lives. As an insurance regulator, I take seriously my duty to ensure that the laws and rules relating to insurance coverage are as inclusive as we would like and that insurers are unable to issue blanket denials based on unintended loopholes in the law.
State law and the federal Affordable Care Act prevent health insurance companies from discriminating against a person because of their gender identity and related medical conditions. These rights apply to young people and adults.
Your rights to coverage
Health insurers generally cannot exclude, deny or limit medically necessary gender affirmation treatments.
Here are some examples of treatments that insurers must cover:
- Hormone therapy
- Consulting services
- Mastectomy and chest reconstruction
- Mammal augmentation
- Hair removal procedures
- Gender-affirming facial procedures
- Tracheal shaves
If you have been wrongfully denied coverage for medical services, you can file a complaint (HERE) and the Office of the Commissioner of Insurance will review it for you. You can also file an appeal (HERE) with your health insurance fund.