BILL NUMBER: S5556
SPONSOR: HOYLMAN-SIGAL
 
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 SPECIFIC PROVISIONS:
Section 1 amends subdivision (1) 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 (ss) 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:
S.3234 of 2023-2024 (Hoylman-Sigal): Passed Senate
S.0726 of 2021-2022 (Hoylman): Died in Insurance
A.1327 of 2021-2022 (Woerner): Died in Insurance
S.5330 of 2019-2020 (Hoylman): Died in Insurance
A.6837 of 2019-2020 (Woerner): Died in 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.

Statutes affected:
S5556: 3216 insurance law, 3216(i) insurance law, 3221 insurance law, 3221(l) insurance law, 4303 insurance law