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IDOI urges ACA federal guarantees to protect against gender-related, sexual orientation discrimination

The Illinois Department of Insurance (IDOI) recently announced its signature on a letter from 21 state Departments of Insurance to the U.S. Secretary of Health and Human Services, Xavier Becerra, urging the finalization of proposed rulemaking to amend regulations that implement Section 1557 of the Affordable Care Act. According to the signed letter, the proposed rule, as outlined in the Notice of Proposed Rulemaking, would promote civil rights protections for millions of health insurance consumers, ensure a level playing field for regulated entities, and enhance state insurance markets.

Illinois remains at the forefront in states’ efforts to ensure federal protections under Section 1557, having previously signed a similar letter in 2020 from state insurance regulators which noted concerns with the Trump Administration’s elimination of explicit nondiscrimination protections based on sex, including gender identity and sex stereotyping.

While Illinois and some other states already have laws affirming protections, insurance regulators point to limited federal guidance as one of the reasons for confusion in the health insurance marketplace and ongoing complaints from consumers who have been denied coverage.

“We’re counting on federal HHS to adopt the proposed rule to further confirm and codify its commitment to advance health equity and reduce disparities in health care,” said IDOI Director Dana Popish Severinghaus. “We take seriously our responsibility to protect consumers, and it’s imperative that we stand together to prohibit any insurers’ attempt to deny coverage to transgender people, LGBTQ people, women, disabled persons, and other historically marginalized populations. Our signed letter also serves as a reminder to health insurance carriers licensed in Illinois that the Department expects full compliance with state and federal laws that protect against gender-related and sexual orientation discrimination to ensure all Illinoisans’ access to care.”

Previously, IDOI, along with the Illinois Department of Human Rights (IDHR), and the Illinois Department of Healthcare and Family Services (HFS), developed legal guidance to assist Illinois employers with compliance. The guidance highlights existing state-mandated nondiscrimination protections and reiterates the mandated requirement for healthcare providers and health insurance companies to provide healthcare services in a non-discriminatory manner. The Reproductive Health Act requires state-regulated private health insurance plans that offer pregnancy-related benefits to cover abortion. The requirement includes plans purchased on the ACA (Affordable Care Act) Health Insurance Marketplace and coverage through an employer that offers a fully insured plan.

IDOI published an FAQ for health insurance coverage for reproductive health care services, including abortion and contraceptives, and the Department’s guidance regarding ACA 1557 can be found here.


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