The Vermont Department of Financial Regulation (the “DFR”) has made it clear that Vermont insurers are prohibited from making coverage determinations for medically necessary gender-affirming care based solely on age.
In 2007, Vermont passed legislation that prohibited discrimination based on gender identity. In 2013, the DFR issued Bulletin 174, stating that the law applies to the coverage of medically necessary gender-affirming care, including gender-affirming surgery. Now, the DFR has revised Bulletin 174.
“The revised bulletin states unequivocally that insurers may not deny coverage of gender affirmation surgery due to the insured's age, unless other clinical factors or circumstances support the decision,” said the DFR's commissioner, Michael Pieciak. “We determined the clarification was necessary after receiving complaints from young Vermonters and their parents that coverage of gender-affirming care had been denied based on age.”
Revised Bulletin 174 comes on the heels of proposed rules issued by the federal government to roll back similar gender identity protections under the Affordable Care Act.
“It is important for Vermonters to know their rights under Vermont law will remain in place regardless of federal action,” said Governor Phil Scott. “I am grateful that my administration is clarifying and strengthening the rights afforded to Vermont's LGBTQ+ community.”
The Scott administration also recently proposed updates to Vermont's health care administrative rules to allow transgender youth under age 21 to undergo gender-affirming surgery through Medicaid.
“This gender-affirming approach helps trans and non-binary youth feel safe in a society that too often marginalizes or stigmatizes anyone seen as different,” said Dana Kaplan, executive director of Outright Vermont. “It's hard enough being a youth, and transgender, in a rural state like Vermont. We are grateful to all our leaders and the incredibly supportive families who have advocated alongside their youth for easier access to care.”
The DFR's revised bulletin applies to private health insurance payers including health insurance companies, nonprofit hospital services corporations, nonprofit medical services corporations, non-ERISA employer group plans, and managed care organizations.
Learn more: Bulletin 174.
Victoria Spears
Victoria Prussen Spears is senior vice president of Meyerowitz Communications Inc., a law firm marketing communications consulting company. A graduate of Sarah Lawrence College and Brooklyn Law School, Ms. Spears was an attorney at a leading New York City law firm before joining Meyerowitz Communications. She may be contacted at [email protected].