N.Y. Comp. Codes R. & Regs. tit. 11 § 52.75

Current through Register Vol. 46, No. 45, November 2, 2024

Section 52.75 - Prohibition on discrimination based on sexual orientation, gender identity or expression, or transgender status

(a) In addition to the prohibitions against discrimination set forth in section 52.72 of this Part, an insurer shall not discriminate based on an insured's or prospective insured's actual or perceived sexual orientation, gender identity or expression, or transgender status. Discrimination prohibited by this section includes any of the following:

(1) including a policy clause that purports to deny, limit, or exclude coverage based on an insured's sexual orientation, gender identity or expression, or transgender status;

(2) denying, limiting, or otherwise excluding medically necessary services or treatment otherwise covered by a policy on the basis that the treatment is for gender dysphoria; provided further that an insurer shall provide an insured with the utilization review appeal rights required by Insurance Law and Public Health Law Articles 49 for gender dysphoria treatment that is denied based on medical necessity;

(3) designating an insured's sexual orientation, gender identity or expression, or transgender status as a pre-existing condition for the purpose of denying, limiting, or excluding coverage; or

(4) denying a claim from an insured of one gender or sex for a service that is typically or exclusively provided to an individual of another gender or sex unless the insurer has taken reasonable steps, including requesting additional information, to determine whether the insured is eligible for the services prior to denial of such claim.

N.Y. Comp. Codes R. & Regs. Tit. 11 § 52.75

Adopted New York State Register April 29, 2020/Volume XLII, Issue 17, eff. 7/28/2020