Ida Hammer v. MVP Health Care (USA)

Ida Hammer, a 34-year-old New York City resident, applied for pre-authorization for male-to-female sex reassignment surgery in July 2011. MVP Health Care denied her claim on the grounds that the surgery was “cosmetic” and therefore was not covered under the policy. MVP later reversed itself after Hammer threatened to sue.

Press Release.

Blog Posts on Ida Hammer.

Blog Post on Ida Hammer.

 

Esquival v. Oregon (USA)

The state of Oregon must provide health insurance coverage for all operations, prescription drugs and other treatments related to medically necessary gender reassignment surgeries, as provided by a settlement with state employee Alec Esquival.  Esquival sued the state and the Public Employees’ Benefits Board on June 21, 2011 after Providence Health, which administered the state’s health insurance program, refused to cover the hysterectomy recommended him by a doctor as part of his transition from woman to man.

News Report.

News Report.

Texas (USA)

A Texas lawmaker has filed a bill to prevent insurers and HMOs from denying health insurance coverage to gay and transgender people if their gender identity or sexual orientation alone would be the basis for the denial.

Senate Bill 73, sponsored by Sen. Rodney Ellis, D-Houston, proposes adding sexual orientation and gender identity to the list of categories protected from discrimination under Texas insurance law.  The bill defines “gender identity or expression” as “a person’s having, or being perceived as having, a gender-related identity, appearance, expression, or behavior, whether or not that identity, appearance, expression, or behavior is different from that stereotypically associated with the person ’s assigned sex at birth.”

S.B. 73.

U.S. Department of Health and Human Services (USA)

The U.S. Department of Health and Human Services clarified that provisions in the Affordable Care Act prohibiting sex discrimination in health insurance apply to transgender people.

Questions and Answers on Section 1557 of the Affordable Care Act

 

  1. Is HHS’ application of Section 1557 of the Affordable Care Act to discrimination based on gender identity and sex stereotyping a new policy? 

    No. HHS clarified that Section 1557 of the Affordable Care Act prohibits discrimination on the basis of gender identity and sex stereotyping.Section 1557’s nondiscrimination requirement applies to any health program or activity, any part of which is receiving federal financial assistance, or under any program or activity that is administered by an Executive Agency or any entity established under Title I of the Affordable Care Act or its amendments. OCR has enforcement authority with respect to health programs and activities that receive Federal financial assistance from the Department of Health and Human Services (HHS) or are administered by HHS or any entity established under Title I of the Affordable Care Act or its amendments.
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