HOUSE OF REPRESENTATIVES

H.B. NO.

285

THIRTY-FIRST LEGISLATURE, 2021

 

STATE OF HAWAII

 

 

 

 

 

 

A BILL FOR AN ACT

 

 

relating to insurance.

 

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 

     SECTION 1.  The legislature finds that many transgender persons have experienced discriminatory treatment from health insurance providers when seeking coverage for gender-confirming 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 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 healthcare providers from discriminating on the basis of gender identity, these protections have been largely rolled back.

     Accordingly, the purpose of this Act is to require health insurance companies to provide applicants and policy holders with clear information on the policy's coverage of gender transition treatments and to prohibit insurance companies from discriminating on the basis of gender identity.

     SECTION 2.  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 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 person's 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 person's family member's actual gender identity or perceived gender identity;

     (3)  Designating a transgender person's or the person's 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 the most recent edition of the Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People, issued by the World Professional Association for Transgender Health.

     (d)  All health care services related to gender transition treatments shall be considered medically necessary and not cosmetic; provided the policy 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;

    (13)  Laser hair removal; and

    (14)  Smoking cessation therapies.

     (e)  Each individual and group accident and health or sickness policy, contract, plan, or agreement shall provide applicants and insured persons 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 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.

     [(e)] (g)  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, or 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, or 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 3.  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 group hospital and 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 person's 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 person's family member's actual gender identity or perceived gender identity;

     (3)  Designating a transgender person's or the person's 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 the most recent edition of the Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People, issued by the World Professional Association for Transgender Health.

     (d)  All health care services related to gender transition treatments shall be considered medically necessary and not cosmetic; provided the policy 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;

    (13)  Laser hair removal; and

    (14)  Smoking cessation therapies.

     (e)  Each individual and group accident and health or sickness policy, contract, plan, or agreement shall provide applicants and insured persons 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 group hospital and 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.

     [(e)] (g)  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, or 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, or 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.  This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date.

     SECTION 5.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 6.  This Act shall take effect upon its approval.

 

INTRODUCED BY:

_____________________________

 

 

 

 

Report Title:

Insurance; Nondiscrimination; Transgender; Gender Transition Treatments

 

Description:

Prohibits health insurance companies from denying coverage on the basis of gender identity if the policy covers the treatment for purposes other than gender transition.  Requires insurance companies 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.

 

 

 

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.