HOUSE OF REPRESENTATIVES |
H.B. NO. |
2405 |
THIRTY-FIRST LEGISLATURE, 2022 |
H.D. 2 |
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STATE OF HAWAII |
S.D. 2 |
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C.D. 1 |
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A BILL FOR AN ACT
RELATING TO INSURANCE.
BE IT
ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. This Act shall be known and cited as the Gender
Affirming Treatment Act.
SECTION 2. The legislature finds that many transgender persons have experienced discriminatory treatment from health insurance providers when seeking coverage for gender affirming treatments. Insurance policies often cover therapies and surgeries like feminizing or masculinizing hormone therapies, voice therapies, chest augmentations or reductions, and genital surgeries for other purposes but deny the same treatments for purposes of gender affirmation.
The legislature further finds that these arbitrary assessments of medical necessity are not evidence-based and interfere with the patient-physician relationship. They also place transgender persons who are denied treatment at higher risk of suicide and depression.
The legislature recognizes that, while federal health care guidelines previously prohibited health insurance and health care providers from discriminating on the basis of gender identity, these protections have been largely rolled back.
Accordingly, the purpose of this Act is to:
(1) Prohibit health insurers, mutual benefit societies, and health maintenance organizations from applying categorical cosmetic or blanket exclusions to gender affirming treatments or procedures when determined to be medically necessary pursuant to applicable law;
(2) Specify a process for appealing a claim denied on the basis of medical necessity; and
(3) Require health insurers, mutual benefit societies, and health maintenance organizations to provide applicants and insured persons with clear information about the coverage of gender transition services, including the process for appealing a claim denied on the basis of medical necessity.
SECTION 3. Section 431:10A-118.3, Hawaii Revised Statutes, is amended to read as follows:
"§431:10A-118.3 Nondiscrimination
on the basis of actual gender identity or perceived gender identity; coverage
for services. (a) No
individual [and] or group accident and health or sickness policy,
contract, plan, or agreement that provides health care coverage shall discriminate
with respect to participation and coverage under the policy, contract, plan, or
agreement against any person on the basis of actual gender identity or
perceived gender identity.
(b) Discrimination under this section includes the following:
(1) Denying,
canceling, limiting, or refusing to issue or renew an insurance policy,
contract, plan, or agreement on the basis of a transgender person's or [the]
a person's transgender family member's actual gender identity or
perceived gender identity;
(2) Demanding or requiring
a payment or premium that is based on a transgender person's or [the]
a person's transgender family member's actual gender identity or
perceived gender identity;
(3) Designating a transgender
person's or [the] a person's transgender family member's
actual gender identity or perceived gender identity as a preexisting condition
to deny, cancel, or limit coverage; and
(4) Denying, canceling, or limiting coverage for services on the basis of actual gender identity or perceived gender identity, including but not limited to the following:
(A) Health care services related to gender transition; provided that there is coverage under the policy, contract, plan, or agreement for the services when the services are not related to gender transition; and
(B) Health care services
that are ordinarily or exclusively available to individuals of [one] any
sex.
(c)
The medical necessity of any treatment for a transgender person, or any
person, on the basis of actual gender identity or perceived gender identity
shall be determined pursuant to the insurance policy, contract, plan, or
agreement and shall be defined in [a manner that is consistent with other
covered services.] accordance with applicable law. In the event of an appeal of a claim denied on
the basis of medical necessity of the treatment, such appeal shall be decided in
a manner consistent with applicable law and in consultation with a health care provider
with experience in prescribing or delivering gender affirming treatment who shall
provide input on the appropriateness of the denial of the claim.
(d) An insurer shall not apply categorical cosmetic
or blanket exclusions to gender affirming treatments or procedures, or any combination
of services or procedures or revisions to prior treatments, when determined to be
medically necessary pursuant to applicable law, only if the policy, contract, plan,
or agreement also provides coverage for those services when the services are offered
for purposes other than gender transition. These services may include but are not limited
to:
(1) Hormone therapies;
(2) Hysterectomies;
(3) Mastectomies;
(4) Vocal training;
(5) Feminizing vaginoplasties;
(6) Masculinizing phalloplasties;
(7) Metaoidioplasties;
(8) Breast augmentations;
(9) Masculinizing chest
surgeries;
(10) Facial feminization
surgeries;
(11) Reduction thyroid
chondroplasties;
(12) Voice surgeries
and therapies; and
(13) Electrolysis or
laser hair removal.
(e) Each individual or group accident and health or
sickness policy, contract, plan, or agreement shall provide applicants and policyholders
with clear information about the coverage of gender transition services and the
requirements for determining medically necessary treatments related to these services,
including the process for appealing a claim denied on the basis of medical necessity.
[(d)] (f) Any coverage provided shall be subject to
copayment, deductible, and coinsurance provisions of an individual [and]
or group accident and health or sickness policy, contract, plan, or
agreement that are no less favorable than the copayment, deductible, and
coinsurance provisions for substantially all other medical services covered by the
policy, contract, plan, or agreement.
(g) Nothing in this section shall be construed to mandate
coverage of a service that is not medically necessary.
[(e)] (h) As used in this section unless the context
requires otherwise:
"Actual gender identity" means a person's internal sense of being male, female, a gender different from the gender assigned at birth, a transgender person, or neither male nor female.
"Gender transition" means the process of a person changing the person's outward appearance or sex characteristics to accord with the person's actual gender identity.
"Perceived gender identity" means an observer's impression of another person's actual gender identity or the observer's own impression that the person is male, female, a gender different from the gender assigned at birth, a transgender person, or neither male nor female.
"Transgender person" means
a person who has [gender identity disorder or] gender dysphoria, has
received health care services related to gender transition, [adopts the appearance
or behavior of the opposite sex,] or otherwise identifies as a gender
different from the gender assigned to that person at birth."
SECTION 4. Section 432:1-607.3, Hawaii Revised Statutes, is amended to read as follows:
"§432:1-607.3 Nondiscrimination on
the basis of actual gender identity or perceived gender identity; coverage for
services. (a) No individual [and] or
group hospital [and] or medical service policy, contract, plan, or
agreement that provides health care coverage shall discriminate with respect to
participation and coverage under the policy, contract, plan, or agreement against
any person on the basis of actual gender identity or perceived gender identity.
(b) Discrimination under this section includes the following:
(1) Denying, canceling,
limiting, or refusing to issue or renew an insurance policy, contract, plan, or
agreement on the basis of a transgender person's or [the] a
person's transgender family member's actual gender identity or perceived
gender identity;
(2) Demanding or requiring
a payment or premium that is based on a transgender person's or [the]
a person's transgender family member's actual gender identity or
perceived gender identity;
(3) Designating a transgender
person's or [the] a person's transgender family member's
actual gender identity or perceived gender identity as a preexisting condition to
deny, cancel, or limit coverage; and
(4) Denying, canceling, or limiting coverage for services on the basis of actual gender identity or perceived gender identity, including but not limited to the following:
(A) Health care services related to gender transition; provided that there is coverage under the policy, contract, plan, or agreement for the services when the services are not related to gender transition; and
(B) Health care services
that are ordinarily or exclusively available to individuals of [one] any
sex.
(c)
The medical necessity of any treatment for a transgender person, or any
person, on the basis of actual gender identity or perceived gender identity
shall be determined pursuant to the [insurance] hospital or medical service
policy, contract, plan, or agreement and shall be defined in [a manner that
is consistent with other covered services.] accordance with applicable law.
In the event of an appeal of a claim denied
on the basis of medical necessity of the treatment, such appeal shall be decided
in a manner consistent with applicable law and in consultation with a health care
provider with experience in prescribing or delivering gender affirming treatment
who shall provide input on the appropriateness of the denial of the claim.
(d) A mutual benefit society shall not apply categorical
cosmetic or blanket exclusions to gender affirming treatments or procedures, or
any combination of services or procedures or revisions to prior treatments, when
determined to be medically necessary pursuant to applicable law, only if that the
policy, contract, plan, or agreement also provides coverage for those services when
the services are offered for purposes other than gender transition. These services may include but are not limited
to:
(1) Hormone therapies;
(2) Hysterectomies;
(3) Mastectomies;
(4) Vocal training;
(5) Feminizing vaginoplasties;
(6) Masculinizing phalloplasties;
(7) Metaoidioplasties;
(8) Breast augmentations;
(9) Masculinizing chest
surgeries;
(10) Facial feminization
surgeries;
(11) Reduction thyroid
chondroplasties;
(12) Voice surgeries
and therapies; and
(13) Electrolysis or
laser hair removal.
(e) Each individual or group hospital or medical service
policy, contract, plan, or agreement shall provide applicants and members with clear
information about the coverage of gender transition services and the requirements
for determining medically necessary treatments related to these services, including
the process for appealing a claim denied on the basis of medical necessity.
[(d)] (f) Any coverage provided shall be subject to copayment,
deductible, and coinsurance provisions of an individual [and] or
group hospital [and] or medical service policy, contract, plan,
or agreement that are no less favorable than the copayment, deductible, and
coinsurance provisions for substantially all other medical services covered by
the policy, contract, plan, or agreement.
(g) Nothing in this section shall be construed to mandate
coverage of a service that is not medically necessary.
[(e)] (h) As used in this section unless the context
requires otherwise:
"Actual gender identity" means a person's internal sense of being male, female, a gender different from the gender assigned at birth, a transgender person, or neither male nor female.
"Gender transition" means the process of a person changing the person's outward appearance or sex characteristics to accord with the person's actual gender identity.
"Perceived gender identity" means an observer's impression of another person's actual gender identity or the observer's own impression that the person is male, female, a gender different from the gender assigned at birth, a transgender person, or neither male nor female.
"Transgender person" means
a person who has [gender identity disorder or] gender dysphoria, has
received health care services related to gender transition, [adopts the appearance
or behavior of the opposite sex,] or otherwise identifies as a gender different
from the gender assigned to that person at birth."
SECTION 5. Section 432D-26.3, Hawaii Revised Statutes, is amended to read as follows:
"§432D-26.3 Nondiscrimination on the basis of actual gender identity or perceived gender identity; coverage for services. (a) No health maintenance organization policy, contract, plan, or agreement shall discriminate with respect to participation and coverage under the policy, contract, plan, or agreement against any person on the basis of actual gender identity or perceived gender identity.
(b) Discrimination under this section includes the following:
(1) Denying, canceling, limiting, or refusing to issue
or renew an insurance policy, contract, plan, or agreement on the basis of a transgender
person's or [the] a person's transgender family member's
actual gender identity or perceived gender identity;
(2) Demanding or requiring a payment or premium
that is based on a transgender person's or [the] a
person's transgender family member's actual gender identity or perceived
gender identity;
(3) Designating a transgender person's or [the]
a person's transgender family member's actual gender identity or
perceived gender identity as a preexisting condition to deny, cancel, or limit
coverage; and
(4) Denying, canceling, or limiting coverage for services on the basis of actual gender identity or perceived gender identity, including but not limited to the following:
(A) Health care services related to gender transition; provided that there is coverage under the policy, contract, plan, or agreement for the services when the services are not related to gender transition; and
(B) Health care services that are ordinarily or
exclusively available to individuals of [one] any sex.
(c)
The medical necessity of any treatment for a transgender person, or any
person, on the basis of actual gender identity or perceived gender identity
shall be determined pursuant to the [insurance] health maintenance organization
policy, contract, plan, or agreement and shall be defined in [a manner that
is consistent with other covered services.] accordance with applicable law.
In the event of an appeal of a claim denied
on the basis of medical necessity of the treatment, such appeal shall be decided
in a manner consistent with applicable law and in consultation with a health care
provider with experience in prescribing or delivering gender affirming treatment
who shall provide input on the appropriateness of the denial of the claim.
(d) A health maintenance organization shall not apply
categorical cosmetic or blanket exclusions to gender affirming treatments or procedures,
or any combination of services or procedures or revisions to prior treatments, when
determined to be medically necessary pursuant to applicable law, only if the policy,
contract, plan, or agreement also provides coverage for those services when the
services are offered for purposes other than gender transition. These services may include but are not limited
to:
(1) Hormone therapies;
(2) Hysterectomies;
(3) Mastectomies;
(4) Vocal training;
(5) Feminizing vaginoplasties;
(6) Masculinizing phalloplasties;
(7) Metaoidioplasties;
(8) Breast augmentations;
(9) Masculinizing chest
surgeries;
(10) Facial feminization
surgeries;
(11) Reduction thyroid
chondroplasties;
(12) Voice surgeries
and therapies; and
(13) Electrolysis or
laser hair removal.
(e) Each health maintenance organization policy, contract,
plan, or agreement shall provide applicants and subscribers with clear information
about the coverage of gender transition services and the requirements for determining
medically necessary treatments related to these services, including the process
for appealing a claim denied on the basis of medical necessity.
[(d)]
(f) Any coverage provided shall
be subject to copayment, deductible, and coinsurance provisions of a health
maintenance organization policy, contract, plan, or agreement that are no less
favorable than the copayment, deductible, and coinsurance provisions for
substantially all other medical services covered by the policy, contract, plan,
or agreement.
(g) Nothing in this section shall be construed to mandate
coverage of a service that is not medically necessary.
[(e)]
(h) As used in this section
unless the context requires otherwise:
"Actual gender identity" means a person's internal sense of being male, female, a gender different from the gender assigned at birth, a transgender person, or neither male nor female.
"Gender transition" means the process of a person changing the person's outward appearance or sex characteristics to accord with the person's actual gender identity.
"Perceived gender identity" means an observer's impression of another person's actual gender identity or the observer's own impression that the person is male, female, a gender different from the gender assigned at birth, a transgender person, or neither male nor female.
"Transgender
person" means a person who has [gender identity disorder or] gender
dysphoria, has received health care services related to gender transition, [adopts
the appearance or behavior of the opposite sex,] or otherwise identifies as
a gender different from the gender assigned to that person at birth."
SECTION 6. This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date.
SECTION 7. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 8. This Act shall take effect upon its approval.
Report Title:
Gender Affirming Treatment Act; Insurance; Nondiscrimination; Transgender; Gender Affirming Treatments
Description:
Prohibits
health insurers, mutual benefit societies, and health maintenance organizations
from applying categorical cosmetic or blanket exclusions to gender affirming
treatments or procedures when determined to be medically necessary pursuant to
applicable law and specifies a process for appealing a claim denied on the
basis of medical necessity. Requires those
entities to provide applicants and insured persons with clear information about
the coverage of gender transition services, including the process for appealing
a claim denied on the basis of medical necessity. (CD1)
The summary description
of legislation appearing on this page is for informational purposes only and is
not legislation or evidence of legislative intent.