EmblemHealth is required to cover gender reassignment surgery and pay $250,000 in civil rights penalties to the state after the attorney general reached a settlement with the not-for-profit insurer, Barbra Underwood's office said on Wednesday.
Emblem, which operates the HIP and GHI plans, will also be required to pay restitution to its members that paid out-of-pocket for their surgeries.
"Health plans have a basic obligation to cover medically necessary health care for their transgender members," Underwood said in a statement. "My office will continue to protect the rights of transgender New Yorkers and ensure they're treated with the fairness and dignity they deserve."
An investigation by the attorney general found that between January 2014 and July 2017, 79 Emblem members sought pre-authorization for gender reassignment procedures. Emblem denied 22 of those requests.
The attorney general said that Emblem gave out "misleading and deceptive" information to members during that time period that was not based on up-to-date medical guidelines which violates state law, the attorney general said. Underwood also said Emblem's review of procedures, such as breast reduction surgery for transgender patients, was "deficient."
Emblem has agreed to update its gender reassignment guidelines and conduct reviews of the criteria it uses to authorize gender reassignment surgeries.
A spokeswoman for Emblem, which insures the majority of municipal workers, said the insurer worked closely with the attorney general on the investigation.
Emblem is "committed to ensuring that our members have access to the care they need," she said.
"New York AG fines Emblem for insufficient coverage of gender-reassignment surgery" originally appeared in Crain's New York Business.