Health plans

Hawaii calls on health plans for more transparency on benefits of gender transition

Insurance regulators in Hawaii want to help residents of the state compare the benefits of the gender transition of health plans.

The effort may mean that agents, brokers, and other benefits advisors in Hawaii – and every state following Hawaii’s lead – will have another coverage detail to explain to clients.

The memo

Hawaii Insurance Commissioner Colin Hayashida outlined the state’s gender transition benefits disclosure guidelines in a new memo.

Related: On Gender, Insurers Should Think Outside the Box

Hayashida called on healthcare providers to post clear and comprehensive summaries of the benefits of gender identity on their websites.

Updates should include descriptions of any coverage for services related to gender transition, Hayashida wrote.

Hayashida addressed the note to health maintenance organizations, and all mutuals that offer health coverage, as well as health insurance companies.

Descriptions of gender identity benefits should be posted on the web “as soon as possible and at the latest, before the effective date of plans for plan year 2022,” Hayashida said.

Hayashida noted that Hawaii’s laws prohibit health plans from discriminating against individuals with respect to participation or coverage, based on real or perceived gender identity.

He also cited a recent initiative by the US Department of Health and Human Services to change the way the HHS interprets a provision in the Affordable Care Act that prohibits discrimination based on sex. The HHS now says it believes the term “discrimination on the basis of sex” includes “discrimination on the basis of sexual orientation” and “discrimination on the basis of gender identity”.


In the past, some people referred to gender transition procedures as “sex reassignment” procedures.

The collaborative effort of the health industry – a consortium of volunteer-led health insurers that includes representatives from many major health coverage providers, including Aetna, Aetna, Cigna, Humana, UnitedHealth and the Centene’s Health Net unit – suggested, in a communication toolkit approved in 2019, that the term “sex reassignment” be used exclusively, and that the use of terms such as “gender affirming surgery” be used and “gender transition” is more sensitive.

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