Oregon Bulletin Provides Interim Guidance for Gender-Affirming Care

On February 1, 2024, the Oregon Department of Consumer and Business Services Division of Financial Regulation issued Bulletin 2024-2, which provides interim guidance for health benefit plans regarding the coverage of gender-affirming treatment consistent with Section 20 of 2023 Oregon House Bill 2002. 

The interim guidance provides that: 

• Carriers may not deny or limit coverage under the plan for gender-affirming treatment that is medically necessary and prescribed in accordance with accepted standards of care. 

• Carriers may not apply a categorical cosmetic or blanket exclusion to medically necessary gender-affirming treatment. 

• Carriers may not exclude, as a cosmetic service, a medically necessary procedure prescribed by a physical or behavioral healthcare provider as gender-affirming treatment. 

• Any adverse benefit determinations that deny or otherwise limit access to gender-affirming treatment must be reviewed and approved by a physical or behavioral healthcare provider with experience prescribing or delivering gender-affirming treatment prior to the issuance of any such adverse benefit determination. 

• Carriers must ensure that enrollees are able to access gender-affirming treatment providers on an in-network basis without unreasonable delay. 

Employers that sponsor health benefit plans offered in Oregon should be aware of the bulletin and contact their carriers for additional information.  

Bulletin DFR 2024-2 Interim Guidance for Health Benefit Plans for Section 20 of 2023 Oregon House Bill 2002 (Gender-Affirming Treatment) »