State employees and covered family members will have health coverage for gender reassignment and other transgender procedures under a new insurance policy that takes effect July 1.
The Public Employee Benefits Program board voted in November to remove language in the state’s self-funded and HMO plans that specifically excluded therapy for gender dysphoria.
Brock Maylath, president of the advocacy group Transgender Allies Group, on Wednesday hailed the change as a “significant step” for the transgender community.
Previous language in the state insurance design plan excluded treatment designed to alter physical characteristics and any other treatment related to sex transformations.
“We commend the Nevada state PEBP board for making this significant step to ensure that transgender employees have access to lifesaving care,” Maylath said. “Medical treatment should be determined by conversations between a patient and a doctor, rather than on arbitrary exclusions created by an insurance company.”
Jeffery Garofalo, a Las Vegas attorney and PEBP board member, said the policy change is a positive step for Nevada.
“I am grateful that our plan documents … are going to be in line with current and modern thinking and respectful of our society,” Garofalo said.
It sends a message, he said, that Nevada “is an enlightened and welcoming place.”
Transgender is an umbrella term for people born one sex but who identify as the opposite sex. Not all transgender people undergo sex-change operations.
Donna Lopez, quality control officer for PEBP, said an actuarial report concluded that providing coverage for gender transformations would have little to no impact on the system’s overall financial health or claims obligations.
Last year, the self-funded program paid out roughly $100 million in claims. It covers more than 40,000 participants and 29,000 family members and survivors. The HMOs also participating include Health Plan of Nevada in the Las Vegas area and Hometown Health in Northern Nevada.
The city of Reno earlier this month also began offering services for transgender procedures.
Under the new policy, PEBP will provide insurance coverage for expenses related to medical, surgical or prescription drug treatment for sex change procedures, including expenses for preparation or complications.
Also covered are gender reassignment procedures encompassing mental health, hormone therapy, prescription drug therapy and genital reconstruction surgery.
There is no maximum benefit limit, though gender reassignment, the physical sex change, is limited to one surgery during an individual’s lifetime while covered under PEBP.
Regular plan deductibles and co-insurance still apply.
Breast enhancements for men transitioning to a woman or breast reductions for women transitioning to a man are covered, as are removal or artificial construction of sex organs.
Procedures considered cosmetic, such as removal of hair and excess skin or nose or chin repositioning, are not covered.
Lopez said the board was supportive of the policy. Minutes from the Nov. 20 meeting show only one board member, Rosalie Garcia, voted against the recommendations of staff. There was no public opposition, Lopez said.
Under the policy, sex change patients would be required to undergo a pre-certification and case management review to assure that any questions a patient might have about the procedures or providers are answered, Lopez said.
Maylath said Nevada joins more than a half-dozen other states that provide transgender health coverage for their employees, including California, Connecticut, Maryland, Massachusetts, New York, Oregon, Washington and the District of Columbia.