DE| Delaware Department of Insurance’s revised Domestic and Foreign Insurers Bulletin No. 86, dated October 20, 2026, reaffirms that nondiscrimination protections based on gender identity and transgender status remain enforceable for health plans regulated by the Department, notwithstanding changes to federal regulations or related litigation. The bulletin emphasizes that carriers must provide equitable access to coverage and benefits, evaluate gender-affirming care using appropriate medical-necessity standards, and eliminate discriminatory policy exclusions or limitations. It states that the guidance takes effect immediately and remains effective unless withdrawn or superseded.
- Coverage and pricing: Insurers may not deny, cancel, limit, refuse to issue or renew coverage, or charge different premiums because of gender identity or gender transition. Medically necessary services cannot be denied based on gender identity when those services would be covered for another individual under comparable circumstances.
- Benefit determinations: Blanket exclusions for gender dysphoria, gender-affirming surgeries, or other transition-related treatments are prohibited, including exclusions justified by lack of FDA approval for gender-transition purposes. Medical-necessity, eligibility, and prior-authorization determinations must reflect current, evidence-based standards established by nationally recognized transgender-healthcare experts.
- Scope and enforcement: The requirements apply to all Department-regulated health plans, including Marketplace qualified health plans and plans offering Essential Health Benefits. The Department will disapprove discriminatory policy forms and may pursue administrative or legal action; Delaware’s appeal and review procedures apply to adverse benefit determinations.