Ill. Admin. Code tit. 50, § 2603.35 - Prohibited Gender Identity Discrimination
a) A company that offers or provides group or
individual health insurance coverage that is neither a grandfathered plan nor a
plan offering excepted benefits shall not discriminate on the basis of an
insured's or prospective insured's actual or perceived gender identity, or on
the basis that the insured or prospective insured is a transgender person. The
discrimination prohibited by this Section includes any of the following:
1) discriminatory exclusionary
clauses;
2) provisions that exclude
from, limit, charge a higher rate for, or deny a claim for coverage of hospital
and medical benefits for gender dysphoria if benefits covered by the policy are
provided for other medical conditions;
3) cancelling, limiting or refusing to issue
or renew an insurance policy on the basis of an insured's or prospective
insured's actual or perceived gender identity , or for the reason that the
insured or prospective insured is a transgender person, or because the insured
or prospective insured has undergone, or is in the process of undergoing,
gender transition ;
4) designating
an insured's or prospective insured's actual or perceived gender identity , or
the fact that an insured or prospective insured is a transgender person, as a
preexisting condition for which coverage will be denied or limited;
5) provisions that exclude from, limit,
charge a higher rate for, or deny a claim for coverage for the surgical
treatments for gender dysphoria;
6)
denying or limiting coverage, or denying a claim, for services due to an
insured's actual or perceived gender identity , or for the reason that the
insured is a transgender person or has undergone, or is in the process of
undergoing, gender transition , including, but not limited to, denials or
limitations relating to health care services that are ordinarily available to
individuals of one sex based on the fact that an individual's sex assigned at
birth, actual or perceived gender identity, or gender otherwise recorded is
different from the one to which such services are ordinarily available;
or
7) denying or limiting coverage,
or denying a claim, for a covered service relating to gender transition based
on a categorical age limitation.
b) Temporary Exemption for Transitional Small
Group Plans. A group plan having fewer than 51 members that was sold before
January 1, 2014 and renewed between January 1, 2015 and October 1, 2015 will
not be required to comply with the requirements of this Section until after the
expiration of the 2015 plan year.
c) Nothing in this Section is intended to
determine, or restrict a company from determining, whether a particular health
care service is medically necessary.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.