Transgender Non-Discrimination in Health Benefits

On Aug. 23, 2018, Superintendent of Insurance Franchini issued Bulletin 2018-013. This bulletin outlines the nondiscrimination rules for the coverage of transgender benefits under New Mexico law. As background, the ACA, the New Mexico Human Rights Act and the New Mexico Insurance Code all have provisions that prohibit discrimination against transgender persons. In accordance with those laws, the New Mexico Office of the Superintendent of Insurance considers exclusions for gender identity or dysphoria-related treatment to be prohibited discrimination on the basis of sex.

As a result, insurers in New Mexico may not:

  • Deny coverage to an individual because they are a transgender person
  • Require different or additional payment from an individual on the basis that they are a transgender person
  • Designate a person’s perceived gender identity as a pre-existing condition for which coverage will be denied or limited
  • Deny or limit coverage for services because the person is transgender, including:
    • Health care services related to gender transition if those services are available to others who are not transitioning gender (such as hormone therapy, counseling, hysterectomy, mastectomy and vocal training)
    • Health care services that are ordinarily or exclusively available to individuals of one sex

This bulletin essentially confirms that New Mexico law seeks to mirror the requirements under the ACA’s Section 1557. Although insurers are ultimately responsible for complying with these requirements, employer plan sponsors should familiarize themselves with these requirements as well.

John G. Franchini. “Bulletin 2018-13.” Bulletins, Office of Superintendent of Insurance, »