Relates to gender indication on insurance claim forms; provides policies shall not exclude coverage if gender indication is different from sex assigned at birth or gender otherwise recorded.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A1682A
SPONSOR: Woerner (MS)
 
TITLE OF BILL:
An act to amend the insurance law, in relation to prohibiting the exclu-
sion of coverage based upon gender indication on claim forms
 
PURPOSE:
The purpose of this bill is to prohibit health insurance claim denials
based on the gender of an insured person.
 
SUMMARY OF PROVISIONS:
Section 1: amends subdivision (i) of section 3216 of the insurance law
to prohibit individual accident and health insurers from excluding
coverage for screening, diagnosis and treatment of medical conditions,
or services otherwise covered by the policy solely on the basis of the
gender indicated on a claim form, or that the gender indicated on a
claim form is different from the insured's sex assigned at birth or
gender otherwise recorded, or that the insured is not of the gender to
whom a service is typically or exclusively provided.
Section 2: amends subsection (1) of section 3221 of the insurance law to
prohibit group insurers from excluding coverage for screening, diagnosis
and treatment of medical conditions, or services otherwise covered by
the policy solely on the basis of the gender indicated on a claim form,
or that the gender indicated on a claim form is different from the
insured's sex assigned at birth or gender otherwise recorded, or that
the insured is not of the gender to whom a service is typically or
exclusively provided.
Section 3: adds a new subsection (uu) to section 4303 of the insurance
law to prohibit group insurers from excluding coverage for screening,
diagnosis and treatment of medical conditions, or services otherwise
covered by the policy solely on the basis of the gender indicated on a
claim form, or that the gender indicated on a claim form is different
from the insured's sex assigned at birth or gender otherwise recorded,
or that the insured is not of the gender to whom a service is typically
or exclusively provided.
Section 4: establishes the effective date.
 
JUSTIFICATION:
It has come to light that health insurers have been denying claims of
transgender individuals because the gender with which the individual
identifies does not match the gender of someone to whom those services
are typically provided. Additionally, claims of transgender individuals
are being denied solely on the basis that the gender on a claim form
does not match the gender on the insurance company's records. This
results in individuals having to appeal these denials, many of which are
subsequently overturned, before they can receive coverage.
This bill addresses these issues and ensures that transgender individ-
uals receive health care coverage in a timely manner by prohibiting
health insurers from denying coverage solely on the basis of the gender
indicated on a claim form, or that the gender on a claim form does not
match the insured's gender otherwise recorded, or that the gender with
which the individual identifies does not match the gender of someone to
whom those services are typically provided.
 
LEGISLATIVE HISTORY:
A.1327 of 2021-22: Referred to Insurance.
S.726 of 2021-22: Referred to Insurance.
A.6837 of 2020: Referred to Insurance.
S.05330 of 2020: Referred to Insurance.
A.11031 of 2017-2018: Referred to Insurance.
 
FISCAL IMPLICATIONS:
None.
 
EFFECTIVE DATE:
This act shall take effect on the first of January next succeeding the
date on which it shall have become law and shall apply to policies and
contracts issued, renewed, modified, altered or amended on and after
such date.
STATE OF NEW YORK
________________________________________________________________________
1682--A
2023-2024 Regular Sessions
IN ASSEMBLY
January 17, 2023
___________
Introduced by M. of A. WOERNER, SIMON, DICKENS, THIELE, CRUZ, GUNTHER,
SEAWRIGHT, GLICK, REYES -- Multi-Sponsored by -- M. of A. SAYEGH --
read once and referred to the Committee on Insurance -- committee
discharged, bill amended, ordered reprinted as amended and recommitted
to said committee
AN ACT to amend the insurance law, in relation to prohibiting the exclu-
sion of coverage based upon gender indication on claim forms
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subsection (i) of section 3216 of the insurance law is
2 amended by adding a new paragraph 39 to read as follows:
3 (39) Every policy that provides coverage for hospital, surgical or
4 medical care shall not exclude coverage for screening, diagnosis and
5 treatment of medical conditions, or services otherwise covered by the
6 policy solely on the basis of the gender indicated on a claim form, or
7 that the gender indicated on a claim form is different from the
8 insured's sex assigned at birth or gender otherwise recorded, or that
9 the insured is not of the gender to whom a service is provided. Nothing
10 herein shall limit the insurer's ability to take reasonable steps,
11 including requesting additional information, to determine whether the
12 insured is eligible for the services, to review the claim for potential
13 fraud, or to review the claim for clinical appropriateness.
14 § 2. Subsection (l) of section 3221 of the insurance law is amended by
15 adding a new paragraph 22 to read as follows:
16 (22) Every policy that provides coverage for hospital, surgical or
17 medical care shall not exclude coverage for screening, diagnosis and
18 treatment of medical conditions, or services otherwise covered by the
19 policy solely on the basis of the gender indicated on a claim form, or
20 that the gender indicated on a claim form is different from the
21 insured's sex assigned at birth or gender otherwise recorded, or that
22 the insured is not of the gender to whom a service is provided. Nothing
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD04905-03-3
A. 1682--A 2
1 herein shall limit the insurer's ability to take reasonable steps,
2 including requesting additional information, to determine whether the
3 insured is eligible for the services, to review the claim for potential
4 fraud, or to review the claim for clinical appropriateness.
5 § 3. Section 4303 of the insurance law is amended by adding a new
6 subsection (vv) to read as follows:
7 (vv) Every contract that provides coverage for hospital, surgical or
8 medical care shall not exclude coverage for screening, diagnosis and
9 treatment of medical conditions, or services otherwise covered by the
10 contract solely on the basis of the gender indicated on a claim form, or
11 that the gender indicated on a claim form is different from the
12 insured's sex assigned at birth or gender otherwise recorded, or that
13 the insured is not of the gender to whom a service is provided. Nothing
14 herein shall limit the insurer's ability to take reasonable steps,
15 including requesting additional information, to determine whether the
16 insured is eligible for the services, to review the claim for potential
17 fraud, or to review the claim for clinical appropriateness.
18 § 4. This act shall take effect on the first of January next succeed-
19 ing the date on which it shall have become a law and shall apply to
20 policies and contracts issued, renewed, modified, altered or amended on
21 or after such effective date.