“We would like all consumers to know that they can shop for health insurance coverage with confidence. All CAHP member carriers are conducting a thorough review of their coverage and processes to ensure they will cover medically necessary services for transgender individuals to the same extent that those services are covered for non-transgender individuals enrolled in the same benefit plan,” said Executive Director Ben Price.
CRS 10-3-1104 prohibits carriers from discriminating against transgender individuals with regard to coverage eligibility, premiums, and benefits payable under a policy. It is important to note that covered services vary from carrier to carrier and from benefit plan to benefit plan. Therefore, it is important to thoroughly review a plan’s Evidence of Coverage (EOC) form before making any purchasing decision. The EOC is the most comprehensive document available that describes which services are available and which services are excluded from a policy. It is also important to note that all benefits are typically subject to the carrier’s medical necessity criteria and clinical guidelines.
Finally, consumers may see “gender identity disorder” (GID) exclusions still listed on carriers’ EOCs. EOC forms currently being used were typically generated last year before further clarity surfaced regarding Colorado’s anti-discrimination laws. As such, consumers should know that carriers are working to ensure GID exclusions listed in current EOCs will not be enforced and that GID exclusions will be removed from future EOCs.
“We understand that potential customers likely have specific questions around what is covered. We recommend that customers start by thoroughly reviewing the plan’s Evidence of Coverage. If questions persist, you are encouraged to contact a health coverage guide, broker, or individual carrier, since benefits vary from carrier to carrier.”
The Colorado Association of Health Plans (CAHP) supports the growth and development of health-delivery systems in their efforts to provide access to high-quality, cost-effective health care to the citizens of Colorado.