On February 23, 2021, the Department of Financial Services (DFS) issued Circular Letter No. 3 to insurers authorized to write accident and health insurance in the state, amongst other entities. The purpose is to direct insurers to provide immediate coverage of diagnostic and treatment services, including prescription drugs, for the diagnosis and treatment of infertility for individuals who are unable to conceive due to their sexual orientation or gender identity and are covered under individual, small group, and large group health insurance policies and contracts.
As background, the state’s definition of “infertility’ has evolved over time. In, 2019, this definition was amended to recognize that the determination of infertility may be made prior to the exhaustion of a 6 to 12 month period resulting in a failure to conceive, if warranted based upon an individual’s medical history or physical findings.
According to the letter, DFS became aware of issuers requiring some individuals to incur costs, due to their sexual orientation or gender identity, that heterosexual individuals do not incur to meet the definition of infertility. The issuers apparently denied coverage of basic infertility treatments for some individuals who were unable to conceive without such treatment due to their sexual orientation or gender identity. This resulted in these individuals incurring high costs of basic infertility treatments for up to 12 months to demonstrate infertility in order to qualify for insurance coverage due to their sexual orientation or gender identity, in violation of the state’s insurance laws.
Therefore, the letter requires issuers to provide immediate coverage for basic infertility treatments that are provided to individuals covered under an insurance policy or contract who are unable to conceive due to their sexual orientation or gender identity to prevent discrimination.
Although the letter is directed at insurers, employers may want to be aware of this communication.
Circular Letter No. 3 »
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