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Ninth Circuit Orders Trial Court to Reconsider Ruling That TPA Violated ACA Section 1557 by Administering Gender-Affirming Care Exclusions (PDF)
Thomson Reuters / EBIA 
Dec. 2, 2025 "The Ninth Circuit's decision highlights the unsettled landscape of Section 1557's application to employer-sponsored health plans and TPAs. It is also part of a wave of litigation over health plan exclusions of coverage for gender-affirming care. As the regulations remain in flux and courts grapple with their interpretation, plan sponsors and TPAs should closely monitor developments and remain mindful that factual nuances may determine liability." [Pritchard v. Blue Cross Blue Shield of Illinois, No. 23-4331 (9th Cir. Nov. 17, 2025)] MORE >> |
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