Department of Financial Services Issues Circular Letter Instructing New York Insurers to Cover Pre-Exposure Prophylaxis - or PrEP - without Cost-sharing, Including Co-pays and Deductibles, Which Have Been a Major Financial Barrier for Many Consumers
New Proposed Regulation Requires Standards for Health Insurer ID Cards to Clearly Indicate Insurer Name, Type of Coverage, Copayment Information, and Member Service Assistance, Among Other Information to Ensure New Yorkers with State-Regulated Health Plans Receive Consumer Protections Guaranteed by State Law
Governor Andrew M. Cuomo today announced new actions to ensure health insurers provide expanded coverage for the HIV-prevention drug PrEP and issue new health insurer ID cards so consumers, including the transgender community, receive the significant protections guaranteed to them under New York State law. As part of this effort, the Department of Financial Services issued a circular letter instructing New York insurers to cover Pre-Exposure Prophylaxis for the prevention of HIV without cost-sharing -- including deductibles and co-pays, which have been a major financial barrier for many consumers. DFS also proposed a new regulation requiring clear standards for health insurer ID cards to ensure all New Yorkers with state-regulated plans, including members of the LGBTQ community, are armed with vital insurance information when they need it.
"With these actions, we are removing a major financial barrier for people who want to take a proven HIV-prevention drug and ensuring people have the information they need at their fingertips to access quality healthcare," Governor Cuomo said. "These policies support our nation-leading campaign to end the AIDS epidemic in New York by the end of 2020 and ensure every New Yorker - regardless of sexual orientation or gender identity - gets the healthcare protections guaranteed to them under law."
"In New York we are proud to be the birthplace of the LGBTQ rights movement, and continue to honor that legacy with our actions," said Lieutenant Governor Kathy Hochul. "We are leading the nation with our efforts to protect the rights of the LGBTQ community, including passing GENDA, banning conversion therapy, and eliminating the gay and trans panic defense - but we still have more work to do to ensure equality for all. These actions will combat discrimination based on sexual orientation, gender identity and expression and make sure all individuals have access to affordable, high-quality health care."
Additionally, DFS issued a circular letter to ensure sexual orientation and gender identity or expression are included among non-discriminatory protections regardless of future federal action. In addition, DFS is providing new consumer information to help transgender New Yorkers who have employer provided health insurance, insurance purchased on the NY State of Health Marketplace, or in the individual market to access coverage for gender-affirming care.
One circular letter issued today reminds health insurers that regardless of federal actions, New York State Law prohibits discrimination based on sexual orientation, gender identity or expression, or transgender status. New York Insurance Law prohibits all insurers from refusing to issue an insurance policy or contract, or cancel or decline to renew a policy or contract, because of the sex or marital status of the applicant or policyholder. Additionally, a second circular letter issued today instructs health insurers to cover all cost-sharing, including deductibles, coinsurance, and copayments, with respect to Pre-Exposure Prophylaxis (PrEP) for the prevention of HIV regardless of any discounts that drug manufacturers may offer. This new guidance provides an important protection to New Yorkers by eliminating by state law a major financial barrier many have faced in obtaining this treatment.
Today's new proposed regulation requires clear standards for health insurer ID cards to ensure all New Yorkers, including members of the LGBTQ community, are armed with vital insurance information. This information includes the issuer's name, and whether the coverage is provided by a health insurer or whether a health insurer is only providing administrative services for an employer-provided, self-funded plan. Many New Yorkers are covered by employer-provided self-funded plans which are governed by federal law and do not afford the same level of consumer protection provided by New York law. Today's new proposed regulation ensures that those covered by state-regulated health plans receive the consumer protections to which they are entitled.
DFS is also providing new consumer information to help transgender New Yorkers who have employer provided health insurance, insurance purchased on the NY State of Health Marketplace, or in the individual market to access coverage for gender-affirming care. Information provided includes insurance coverage subject to and exempt from New York protections, gender-affirming treatment insurers are required to cover, how to appeal denials, surprise billing protections, and information on how to file complaints.
"DFS is proud to step up in support of the Governor's agenda and on behalf of all New York consumers to provide vital protections for all," Department of Financial Services Superintendent Linda Lacewell said. "We will continue to use our full authority to push back against federal efforts to roll back coverage and ensure that New Yorkers receive the health care they deserve without discrimination, regardless of sexual orientation, gender identity or expression."
Department of Health Commissioner Dr. Howard Zucker said, "While LGBTQ individuals need the same health care as other New Yorkers, they often face additional barriers to accessing services. At Governor Cuomo's direction, New York State has led a path forward to ensure that there is equity in access to health care regardless of a person's sexual orientation or gender identity."
Throughout his administration, Governor Cuomo has been a champion of LGBTQ rights, most notably passing the Marriage Equality Act in 2011. Earlier this year, the Governor signed the Gender Expression Non-Discrimination Act, prohibiting employers, educational institutions, landlords, creditors, and others from discriminating against individuals on the basis of gender identity or expression, and making offenses committed on the basis of gender identity or expression hate crimes under New York State law. The Governor also signed legislation banning the practice of conversion therapy by expanding the definition of professional misconduct for professions licensed under the education law to include engaging in conversion therapy with a patient under the age of eighteen years.
Most recently, in anticipation of the potential rollback of critical Affordable Care Act provisions, Governor Cuomo directed the Department of Health to issue regulations prohibiting health care providers from discriminating against transgender patients, and directed the Department of Financial Services to issue regulations expanding anti-discrimination protections for transgender individuals when accessing health insurance. These directives were in direct response to the Trump administration's proposal to repeal a federal regulation that clarifies that the Affordable Care Act's non-discrimination protections based on sex include protections based on gender identity. By removing these protections, approximately 90,300 transgender New Yorkers would be exposed to unfair, blatant and unlawful discrimination.