Transgender Delawareans to receive guaranteed healthcare coverage

The Delaware Insurance Commissioner announced Wednesday that providers cannot refuse coverage, impose unequal premiums or exclude gender transition care.

Insurance companies have denied care for transgender Delawareans for years—forcing them to either face the financial burden of paying out of pocket or face the emotional and physical consequences of living without necessary care.

“It’s almost a near universal experience where their insurance plans included categorical exclusions for any care related to gender transition,” said Sarah McBride, a transgender woman and LGBT advocate.

“For transgender people about to transition they almost always uniformly experience barriers to the type of care they need to live and thrive.”

But now transgender men and women will receive the health care they’ve been fighting for.

Delaware is the 15th state to ban exclusions for transition-related care, and now it’s penalizing insurance companies that don’t abide to state law.

Insurance Commissioner Karen Weldin Stewart announced Wednesday that Delaware insurance providers cannot refuse coverage, impose unequal premiums or exclude gender transition care.

“All Delawareans should have access to quality health care, regardless of their gender identity,” she said. “The Insurance Department will be vigilant in making sure all insurers comply with the law.”

The requirement, known as the Domestic and Foreign Insurers Bulletin, No. 86, is imposed on all insurers and insurance plans regulated by the Delaware Department of Insurance, stating: “Any blanket policy exclusion for gender dysphoria, gender identity disorder, medically necessary surgeries or other treatments related to gender transition or related services is a violation of the Unfair Trade Practices Act.” 

The Gender Identity Nondiscrimination Act was passed by the Delaware General Assembly and signed by Gov. Jack Markell, D-Delaware, in 2013, aiming to end discrimination based on gender identity. Even though three years have passed, Stewart said insurance companies still aren’t complying with the language in the legislation.

The Insurance Department has received complaints surgery is not approved or covered by insurance companies, she said. Stewart said her office also has engaged with the community about the issue.

“I’ve been hearing from the community that companies aren’t necessarily interpreting the (Gender Identity Nondiscrimination) Act in a way it was intended,” she said.  “We’re hoping this Bulletin will define how the spirit of the legislation was written and adopted.”

McBride, a board member at Equality Delaware, said many transgender individuals must pay out of pocket for the care they need, but often the prices are too expensive.

Treatment costs vary, but hormone treatment could cost several hundreds of dollars a month and surgery could cost anywhere from a couple thousand dollars to 10’s of thousands of dollars, said McBride, who also serves as the campaigns and communications manager for LGBT progress at the Center for American Progress.

Despite those costs, removing the exclusions wouldn’t result in increased premiums, she said.

Sometimes transgender individuals raise money to fund their health care, or seek out cheap options that can be dangerous, McBride said.

“It’s becoming more common for individuals to raise funds among their friends, or individuals who attempt to get the care they need on the black market,” she said.

“But mostly people end up, if they can’t afford it, suffering with the inability to get the care—and that has negative health outcomes for those transgender folks long-term, and has an effect on increasing costs because they’re accessing a system they otherwise wouldn’t have to get.”

Lisa Goodman, president of Equality Delaware, also said many of the treatments and surgeries excluded for gender transition are the same as those still covered for non-transgender patients.

“Delaware already is very welcoming for LGBT people, but transitional healthcare for transgender people is a very important step, and this Bulletin makes it clear transgender Delawarean’s coverage is just as important as any other Delawarean,” she said.  

The Insurance Department said it will take administrative or legal action against any insurance company licensed to do business in Delaware that fails to comply with the Unfair Trade Practices Act, as amended by the Gender Identity Nondiscrimination Act, or other State law.

Large businesses often are self-insured, which means they don’t necessarily recognize state law. The State of Delaware, however, is self-insured but usually adopts any mandate, Stewart said.

When the Insurance Department receives a complaint it advocates on the behalf of the consumer. If the department finds the company isn’t complying to the law the way it’s intended it fines them anywhere from $1,000 to $5,000 per violation.

“It reinforces that Delaware is a welcoming and inclusive place for people to live and work. It demonstrates to businesses out of state that Delaware is an environment where all workers will get the health care they need,” McBride said.

“It’s going to have a life-saving impact on hundreds of transgender people who live throughout the state, who not just want but need necessary health care, who were previously denied. But the impact on that cannot be understated enough.”