Lawsuit Over Health Insurance Coverage for Gender Reassignment will Proceed

By Heather Bredeson - Seaton Peters & Revnew, P.A.

September 27, 2018

A lawsuit against Essentia Health and HealthPartners regarding denied coverage for gender transition care has been allowed to proceed past a motion to dismiss.  Tovar v. Essentia Health, No. 16-cv-100-DWF-LIB (D. Minn. Sept. 20, 2018).  Plaintiff Brittany Tovar was an employee of Essentia and received health insurance benefits.  She later added her son as a beneficiary.  He was diagnosed with gender dysphoria, and his doctors deemed gender transition care medically necessary.  His doctor recommended that he begin taking two medications to treat gender dysphoria.  Tovar sought coverage for these medications as well as pre-authorization for gender reassignment surgery for her son through the plan, but HealthPartners, Essentia’s health plan administrator, denied coverage.  At that time, the Essentia plan categorically excluded coverage of services for gender reassignment.

Tovar and her son sued HealthPartners and Essentia in the District of Minnesota federal court under the Affordable Care Act (“ACA”).  HealthPartners and Essentia moved to dismiss the case.  The judge ruled that denying insurance coverage for transgender health care is unlawful under Obama-era administrative rules interpreting the ACA.

While the Trump administration has stated it will submit new regulations to remove transgender health protections under the ACA, it has not yet done so.  Various courts have also determined that gender identity discrimination is unlawful sex discrimination under federal Title IX and Title VII.  Employers should be mindful of these issues when selecting health plan benefits for employees.