Your rights under the Gender Affirming Treatment Act

Read this to learn about a new law in Washington that protects against health insurance discrimination based on gender identity and related medical conditions.

It is a new law in Washington that protects the rights of insured individuals who are seeking coverage for gender affirming medical treatment.

Effective January 1, 2022, your health insurance carrier cannot deny or limit coverage through cosmetic or blanket coverage bans for gender affirming treatment when:

• the treatment is related to your gender expression or identity,

• your doctor says the treatment is medically necessary, and

• it is a recognized and accepted treatment in the medical community.

Gender affirming treatment includes, but is not limited to, all treatment that is prescribed by your doctor to treat gender dysphoria or gender identity related medical conditions.

Gender affirming treatment can be provided to individuals who seek such treatment related to their gender identity. Some people who seek gender affirming medical treatment may identify as two spirit, transgender, nonbinary, intersex, or other gender identities.

Yes. These rights apply to both youth and adults.

Coverage details including covered providers, timelines, deductibles, and coverage rates will be specific to each insurer and to your individual health plan.

However, health insurers generally cannot exclude, deny or limit medically necessary gender affirming treatment through claiming that treatments are "cosmetic" or through "blanket" coverage bans which exclude gender affirming treatments.

Gender affirming treatment should be covered when:

• prescribed by your doctor as medically necessary treatment related to your gender expression or gender identity and

• the type of the treatment is recognized and accepted in the medical community.

These are some of the treatments that should be covered under the new law:

• facial feminization surgeries

• gender affirming facial procedures

• tracheal shaves

• hair electrolysis and hair removal procedures

• mastectomies

• breast reductions

• breast implants

• chest reconstruction

• breast augmentation

• gender affirming genital surgery

• hormone therapy

• counseling services

Yes. A health insurance carrier can deny or limit access to gender affirming services if they have a health care provider (who has experience with gender affirming treatment) review your request and determine that it is not medically necessary to treat gender dysphoria.

No. Under the new law, your health insurance carrier cannot have a policy that excludes all gender affirming treatment from being covered under your plan. The new law protects against these kind of "blanket" exclusions. Coverage details and specifics will be unique to your health insurance carrier and health plan.

Yes. The new law applies to all insurance carriers who provide health insurance in Washington State.  Your health plan carrier may limit coverage if it limits coverage for other similar non-gender related treatments.For example, if your health plan does not otherwise provide coverage for hormones, then your health carrier may also limit coverage for gender related hormone treatment. But, your health carrier cannot cover hormone treatment for non-gender related issues and then deny coverage for gender related hormone treatments.

Your health insurance carrier cannot refuse to cover gender affirming treatment by claiming that the treatment is cosmetic.

If your doctor prescribes the treatment as medically necessary related to your gender identity, a health insurance carrier must cover your gender affirming treatment.

If your coverage request was denied, you can appeal the decision with your insurance. You can learn more about how to file an appeal through the Washington Office of the Insurance Commissioner's website.

Under the Gender Affirming Treatment Act, no matter where you live, your health insurance carrier is responsible for making timely and geographically accessible treatment available to you.

This includes providing case management services to secure out-of-network gender affirming treatment options if none are available in your area.

You will not have to pay any more for out-of-network options than the same cost sharing that you would pay for the same covered services received if there was an in-network provider available.

• You can file a complaint. The Washington Office of the Insurance Commissioner will investigate complaints related to gender discrimination medical coverage denials. You can make a complaint online (bit.ly/3a8rxgR).

• You can file an appeal with your insurance carrier. You can appeal a denial of a request for coverage. You can ask your insurance carrier about how to appeal the denial. You can also learn more about how to appeal a denial at the Washington Office of the Insurance Commissioner about appealing health insurance denials.

• You can contact a lawyer. A lawyer may be able to give you more information about your rights and protections under this law.

The QLaw Foundation of Washington promotes the dignity and respect of LGBTQ+ Washingtonians within the legal system through advocacy, education, and legal assistance.

QLaw offers a resource and education page where you can learn more about gender identity related rights and find their in-depth resource guide to the new law and its protections.

You also may be able to get help at the QLaw LGBTQ+ Legal Clinic.