Gender-Affirming Care and Group Health Plans: Insured vs. Self-Funded Plans, Applicable Federal Laws, State Law Issues

Strafford

This CLE webinar will provide employee benefits and ERISA counsel a detailed analysis of the current state of gender-affirming care and navigating the challenges faced by health plan sponsors and administrators. The panel will discuss applicable federal regulations that must be considered, including the ERISA preemption doctrine, Affordable Care Act (ACA), MHPAEA, and HIPAA, along with state law issues that may arise. The panel will also discuss current approaches to gender-affirming coverage and offer best practices for insured and self-funded plans and pitfalls to avoid.

Description

Gender-affirming care has been a hot topic among federal and state regulators for the past couple years. Plan sponsors and administrators struggle with navigating conflicting state laws while also trying to maintain compliance with applicable federal laws. Attorneys, plan sponsors, and administrators must have a firm understanding of applicable federal and state laws and current approaches to gender-affirming coverage.

Interpretive guidance has been issued covering a number of issues stemming from recent federal regulations impacting employer-sponsored group health plans. In addition, states have been aggressive in their regulation of licensed health insurance carriers and self-funded plans; specifically as such relates to gender-affirming coverage.

Multiple states have drawn hardlines when it comes to health plans providing or excluding gender-affirming coverage. Self-funded plans that exclude gender-affirming care within their plan documents could face potential discrimination concerns. However, this depends on what laws are applicable to the plan as certain state laws may not apply to a self-funded plan governed by ERISA due to ERISA preemption. Therefore, any state laws that may require coverage or ban coverage for gender-affirming care would not apply to an ERISA plan, which allows an ERISA plan the ability to cover or exclude benefits for gender-affirming care, subject to certain requirements as other ERISA plans.

Listen as our panel discusses applicable federal regulations that must be considered for gender-affirming coverage, including the ERISA preemption doctrine, ACA, MHPAEA, and HIPAA, along with state law issues that may arise. The panel will also discuss current approaches to gender-affirming coverage and offer best practices for insured and self-funded plans.

Outline

1. Current state of gender-affirming care and benefits
2. Applicable federal laws
3. Challenges for insured and self-funded health plans
4. Recent state law developments and key issues
5. Best practices for gender-affirming coverage

More Information, How to Register