Anti-Transgender Exclusion Removed from Colorado Group Health Plan

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June 10, 2020

Niamh Anderson took all the necessary steps in preparation for their gender confirming procedure last July, including securing prior insurance authorization for a surgery doctors had said was medically necessary to treat their gender dysphoria. So Anderson, a paramedic then-employed with of the Town of Limon, was stunned to learn that the town’s health insurance plan administrator denied several claims for the procedure because of a blanket exclusion that effectively precludes any gender affirming healthcare. Without coverage for the procedure, Anderson was facing medical bills exceeding $40,000.

After trying to navigate through insurance appeals on their own, Anderson, who is nonbinary and uses they/them pronouns, reached out to Lambda Legal’s Help Desk for assistance. Lambda Legal lawyers filed charges of discrimination on Anderson’s behalf with the Colorado Civil Rights Division (CCRD) against the Town of Limon, the Colorado Employer Benefit Trust (CEBT) and health plan administrators—alleging violations of the Colorado Anti-Discrimination Act (CADA), which prohibits discrimination on the basis of sexual orientation and gender identity in employment, as well as, housing and public accommodations.  

Shortly after receiving notice of the charges, the Board of Trustees of CEBT took prompt action to resolve the matter. As part of an agreement with Anderson, CEBT reprocessed and paid all of Anderson’s previously rejected claims; removed the categorical transgender healthcare exclusion from the plan; included an express statement that medically necessary gender confirming procedures are covered for all plan participants; and, provided notice on their website of the policy change to all plan participants.

“When it comes right down to it, doing the right thing for transgender and nonbinary employees is really not that hard,” said Avatara Smith-Carrington, Tyson Garner Memorial Law Fellow at Lambda Legal. “Far too many health insurance policies across the country still include unlawful anti-transgender exclusions. And even when the discriminatory exclusion is called to the attention of the insurer, many prefer a protracted legal battle rather than simply correcting the problem. We commend CEBT for removing a barrier to adequate healthcare for all transgender and nonbinary plan participants and encourage other keepers of the public trust to be similarly clear-sighted.” 

“This is such a relief,” Anderson said. “I was pretty devastated when I learned that my insurance claims had been rejected, because I was really careful to get all the necessary pre-approvals before having the procedure. So, it was great the folks at CEBT quickly took steps to remove the exclusion and make things right.”

According to its website, the Colorado Employer Benefit Trust is a multiple employer trust for public institutions providing employee benefits. Created in 1980, CEBT has grown to approximately 33,000 members and more than 350 participating groups, including municipalities, school districts, and other governmental entities across Colorado. 

The case is In re Anderson.  Further information about the amendments to the CEBT EPO Medical Plan and CEBT PPO and High Deductible Medical Plan are available on the CEBT website.

Avatara Smith-Carrington, Carl Charles and Paul D. Castillo worked on the case for Lambda Legal, joined by Mari Newman and Liana Orshan of Killmer, Lane & Newman, LLP in Denver, Colorado.