Section 1557 of the Affordable Care Act (ACA) prohibits a covered entity from discriminating in its health programs or activities on the basis of an individual's sex, as well as other factors. Most of the state BlueCross program like Blue Cross of Tennessee, Humana, United, Aetna, Anthem and almost every carrier out there is a covered entity, and subject to the prohibitions contained in 1557, as long as they receive federal financial assistance through Marketplace and/or Medicare Advantage health plans.
The Office of Civil Rights (OCR) recently expanded the prohibition on the basis of sex to include sex stereotyping and gender identity. The updated rule states:
· Members may not be denied coverage, or have coverage limited, based on their sex, including their gender identity.
· Members may not be limited or denied sex-specific health care only because the person seeking such services identifies as another gender.
· Categorical exclusions of coverage for all health services related to gender transition are inherently discriminatory.
While this rule became effective July 18, 2016, required changes to health insurance or group health plan benefit designs (e.g., cost sharing, covered benefits, or benefit limitations or restrictions) may be made on the first day of the first plan year beginning on or after January 1, 2017.
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Grace & Peace,
Andrew Darlington CRM, CIC, CBIA, AAI
***Typed qith tumbs or used voice to text soplease forgive the gramatical errora.***
Veritas Risk Management & Insurance Services
PO Box 4539 Johnson City, TN 37602
Phone- (423)292-4142
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