Plan Coverage of Gender Dysphoria and SCOTUS Decision on Title VII

The Supreme Court of the United States (SCOTUS) recently held that Title VII of the Civil Rights Act prohibits discrimination based on an individual’s sexual orientation and transgender status.  ASR has taken the position that this decision triggers liability under Title VII for employers that currently exclude gender dysphoria under their health benefit plans because federal employment discrimination law extends to benefits.  While a blanket exclusion will no longer be allowed, medical management will be permissible.

Although the exact onus on health benefit plans as a result of the SCOTUS decision is unclear, ASR recommends that the guidelines for coverage of gender dysphoria outlined in Section 1557 be the standard (regardless of whether the employer sponsoring the health benefit plan is subject to Section 1557): charges for medically necessary services or treatment in connection with gender dysphoria, such as reassignment surgery, hormone replacement therapy, and related lab tests.

Penalties for non-compliance could be significant: EEOC investigation and penalties or employee lawsuits with mandated coverage as well as damages for emotional distress, punitive damages, attorney fees, and court costs running into hundreds of thousands of dollars.

If you have questions about the SCOTUS decision as it relates to your health benefit plan, call ASR Health Benefits at (616) 957-1751 or (800) 968-2449.