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Revised January 6, 2017

Update: GIB Action Related to Health Coverage Based on Gender Identity

The Group Insurance Board (GIB) held a special meeting on December 30, 2016 to revisit a benefit exclusion related to gender identity.

2017 Uniform Benefits no longer include a blanket exclusion related to benefits and services based on gender identity.

However, the GIB voted to reinstate the exclusion if all of the following were to occur:

  1. A court ruling or an administrative action that enjoins, rescinds or invalidates the rules set by the federal Department of Health and Human Services (HHS);
  2. Compliance with state law, Section 40.03 (6)(c);
  3. Renegotiation of contracts that maintain or reduce premium costs for the state; and
  4. A final opinion of the Wisconsin Department of Justice (DOJ) that the action taken does not constitute a breach of the GIB’s fiduciary duties.

The following provides an update of each of the contingencies as of January 4, 2017:

  1. This contingency has been met. A federal judge issued a preliminary injunction on December 31, 2016.
  2. This statute provides parameters for modifications to benefits:
    • Modifications must be either required by law, or
    • Maintain or reduce premium costs for the state or its employees in the current or any future year.
      • Health plans did not itemize an increase associated with removing the exclusion for their 2017 premium negotiations.  Therefore, ETF did not see an increase in health plan premiums due to this coverage.
      • ETF does not anticipate a premium reduction due to the reinstatement of the exclusion.
  3. This contingency would entail an amendment to 2017 health plan contracts to reinstate the exclusion.
  4. The DOJ has not issued a final opinion at this time.

Through December 31, 2016, Uniform Benefits contained exclusions related to benefits and services based on gender identity. This meant that certain medical and pharmacy benefits would be denied if they were not classified as medically necessary for the patient’s recorded sex. An exclusion also specifically stated that services related to gender transformation were not covered.

The GIB approved the removal of the exclusion in July of 2016 to comply with federal regulations issued in May of 2016. The change was effective January 1, 2017.

In the event all of the contingencies are met, this policy will be revisited to determine if changes will be made.

It is unknown when the contingencies could be met. It is also unknown exactly how claims will be handled for in-process services if or when all contingencies are met. ETF will provide the GIB with updates on the contingencies and will notify employers, health plans and affected members if changes will be implemented.

Next Steps
It is ETF’s priority to keep members, employers, staff and vendor partners informed of time-sensitive benefit and policy issues.  Future updates will be provided as soon as more information is known.

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