OR| The Oregon Office of Secretary of State issued a Permanent Administrative Order (ID 41- 2024) on behalf of the Department of Consumer and Business Services – Insurance Regulation on new administrative rules for gender-affirming treatment coverage in Oregon, effective January 1, 2025. These rules aim to ensure that health insurance carriers provide comprehensive coverage for medically necessary gender-affirming treatments without undue limitations or denials.
Key points:
- Health benefit plans cannot deny or limit coverage for medically necessary gender-affirming treatments prescribed in accordance with accepted standards of care.
- Carriers are prohibited from applying categorical cosmetic or blanket exclusions to medically necessary gender-affirming treatments.
- Adverse benefit determinations must be reviewed by experienced providers with specific qualifications in gender-affirming care.
- Carriers must ensure adequate network coverage for gender-affirming treatment providers or provide access to out-of-network services without additional cost to enrollees.
- The rules adopt the World Professional Association for Transgender Health’s Standards of Care (WPATH-8) as a minimum standard for accepted care.
Click here to see Permanent Administrative Order (ID 41- 2024)