Transition-Related Care Exclusions Banned in Maryland Small-Group, Individual, and Student Health Insurance Plans

Maryland Insurance Administration: "This type of exclusion is a discriminatory benefit design."


Press Contact: Patrick A. Paschall
Office: 410-625-5428 x11
Cell: 409-771-6763

Baltimore, MD – February 9, 2016 – FreeState Legal and Equality Maryland have learned that the Maryland Insurance Administration has recently issued bulletins prohibiting individual, small-group, and student health insurance plans sold in Maryland from excluding coverage for health care for the purpose of gender transition. This announcement follows longstanding advocacy by FreeState Legal and Equality Maryland, most recently including a request to the federal Center for Consumer Information and Insurance Oversight asking federal regulators to require Maryland to prohibit transition-related care exclusions from appearing in these state-regulated insurance plans that are governed by the federal Affordable Care Act.

“We applaud the Maryland Insurance Administration for prohibiting this discriminatory exclusion that has become a fixture in health insurance plans and that has significant harm to the transgender community,” said Patrick A. Paschall, Executive Director of FreeState Legal and Equality Maryland. “Transition-related care exclusions serve no other purpose than to discriminate against transgender people. To deny life-saving medical care to an entire population based solely on the fact that they identify as transgender is not only unconscionable, but we believe a violation of federal law. We are glad that the Maryland Insurance Administration agrees that transition-related care exclusions violate federal law and has taken action to ensure that the individual, small-group, and student plans it regulates no longer discriminate on the basis of gender identity.”

The Maryland Insurance Administration bulletins, issued on December 7 and 10, 2015, inform health insurers that transition-related care exclusions will no longer be permitted as the agency reviews and approves individual and small-group health plans for the 2017 plan year and student health plans for the 2016-17 school year. The bulletins require carriers to update their plans, and clarify that the requirement applies to plans that are sold either through the ACA exchange or off the exchange.

The Administration based its decision on an existing federal regulation, 45 CFR § 156.200(e), issued in 2012, that prohibits discrimination in qualified health plans on the basis of personal characteristics such as gender identity. In the recent bulletins, the Maryland Insurance Administration ruled that transition-related care exclusions can no longer appear in small-group, individual, and student plans because “federal guidance has determined that this type of exclusion is a discriminatory benefit design,” prohibited by the federal regulation.

“We hope this sends a clear message to insurers that denial of transition-related health care solely because the patient is transgender is unlawfully discriminatory, and that the federal regulations on which the agency based its decision are currently in effect,” said Paschall. “We believe that discrimination against transgender people in all health insurance plans is against the law, and we at FreeState Legal and Equality Maryland will continue to bring legal action against insurers that discriminate and employers that choose discriminatory plans. We will not stop until all transgender people in Maryland have full and equal access to the health care they need.”

Maryland Insurance Administration Bulletin 15-33, applicable to the individual and small-group markets, is available at The prohibition of transition-related care exclusions appears at the top of page 6 of the bulletin. Maryland Insurance Administration Bulletin 15-32, applicable to student health plans, is available at The prohibition of transition-related care exclusions appears on the first page of the bulletin.


FreeState Legal is a non-profit organization that serves the low-income lesbian, gay, bisexual, transgender, and queer (LGBTQ) community in Maryland through direct legal services, impact litigation, policy advocacy, and outreach and training activities. Equality Maryland is Maryland’s largest LGBTQ civil rights and political advocacy organization, with thousands of members statewide, lobbying in Annapolis and across the state to create equal protection under the law for LGBTQ Marylanders and their families through public education, outreach, training and organizing. FreeState Legal and Equality Maryland recently announced that they are merging to form a comprehensive, statewide civil rights organization that serves LGBTQ Marylanders through litigation, policy advocacy, community outreach, public education, and training.


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