Insurance Coverage for Transgender New Mexicans

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In light of the recent Trump memo that attempts to continue the systematic neglect and discrimination against transgender Americans, the LGBTQ+ community must understand our rights – especially on issues as important as health care.

Today, we are excited to announce a big win for the transgender and gender-expansive community in New Mexico.

In late August, the New Mexico Office of Superintendent of Insurance issued the “Transgender Non-Discrimination in Health Insurance Benefits” bulletin. This bulletin does not change any New Mexico laws or regulations; rather, it helps insurance companies and consumers understand their obligations and rights under state and federal law.

What does the bulletin say?

Specifically, the bulletin makes it clear that private insurance plans sold in New Mexico cannot, among other things:

  1. Deny or limit coverage for services related to gender transition if coverage is available for those services under the policy when the services are not related to gender transition (e.g. hormone therapy, counseling, hysterectomy, mastectomy or vocal training).

  2. Deny or limit coverage of procedures commonly associated with a particular sex (e.g. pap smears or prostate exams) when those services are clinically necessary.

  3. Consider someone’s gender identity or transgender status as a preexisting condition.

  4. Deny, limit, or refuse to renew an insurance policy because of someone’s gender identity.

How do we use this bulletin?

This bulletin is an important tool for transgender consumers to advocate for themselves with their insurance companies to get the care they need, including transition-related care. For example, if you are trying to get coverage related to gender transition, you can include or reference this bulletin in your request for preauthorization.

Remember: you still need to provide to the insurance company documentation from a qualified physician to demonstrate the procedure for which you seek coverage is medically necessary.

Consumers who believe they were discriminated against in insurance for being transgender can file complaints with the New Mexico Office of Superintendent of Insurance.

Open Enrollment

Open enrollment for the Affordable Care Act begins November 1 and goes until December 15. To compare health care plans, use the OSI’s plan comparison tool. You can also check out Out2Enroll for specific plan information on transition-related care.

Questions?

If you have questions about what this bulletin means, feel free to contact us at 505-200-9086 or tgrcnm@tgrcnm.org, Equality New Mexico, or the National Center for Transgender Equality.

What’s Next?

While this is a big win for New Mexicans, we still have work to do. Even with the federal government playing political games with our lives, we have the opportunity to deepen protections for transgender New Mexicans. In the next legislative session, we will re-introduce the Vital Records Modernization Act which will allow folks to amend their birth certificate to affirm their gender, including having a third marker - an “X” to indicate nonbinary, undesignated, or other.

We need your help to pass this bill. Together with Equality New Mexico and the National Center for Transgender Equality, we are working to get this bill to the Governor’s desk in 2019. That’s where you come in:

You’ll get notified of opportunities to volunteer and help us deepen protections for trans and gender-expansive New Mexicans.