Health Insurance and Oregon Law

On July 13, 2023, Governor Tina Kotek signed House Bill 2002 into law. Section 20 of the bill establishes health insurance coverage requirements for gender-affirming care. Part 2 of Section 20 says the following:

“(2) A carrier offering a health benefit plan in this state may not:
(a) Deny or limit coverage under the plan for gender-affirming treatment that is:
(A) Medically necessary as determined by the physical or behavioral health care provider
who prescribes the treatment; and
(B) Prescribed in accordance with accepted standards of care.
(b) Apply categorical cosmetic or blanket exclusions to medically necessary gender-
affirming treatment.
(c) Exclude as a cosmetic service a medically necessary procedure prescribed by a phys-
ical or behavioral health care provider as gender-affirming treatment, including but not
limited to:
(A) Tracheal shave;
(B) Hair electrolysis;
(C) Facial feminization surgery or other facial gender-affirming treatment;
(D) Revisions to prior forms of gender-affirming treatment; and
(E) Any combination of gender-affirming treatment procedures.
(d) Issue an adverse benefit determination denying or limiting access to gender-affirming
treatment unless a physical or behavioral health care provider with experience prescribing
or delivering gender-affirming treatment has first reviewed and approved the denial of or the
limitation on access to the treatment.”

In other words, health insurance companies operating in Oregon have to cover gender-affirming care prescribed by a healthcare provider, including electrolysis. This applies to all healthcare providers operating in Oregon. I’ve talked to some people who think that health insurance companies based outside of the state aren’t bound by Oregon’s state law. This is not true, and it’d be an insane loophole if it were. Some health insurance companies may try to deny coverage anyway. Understand that if they do, they’re breaking the law, and you can challenge the denial on these grounds.

Part 3 of this section may also be useful:

“(3) A carrier described in subsection (2) of this section must:
(a) Satisfy any network adequacy standards under ORS 743B.505 related to gender-
affirming treatment providers; and
(b)(A) Contract with a network of gender-affirming treatment providers that is sufficient
in numbers and geographic locations to ensure that gender-affirming treatment services are
accessible to all enrollees without unreasonable delay; or
(B) Ensure that all enrollees have geographical access without unreasonable delay to
out-of-network gender-affirming treatment services with cost-sharing or other out-of-pocket
costs for the services no greater than the cost-sharing or other out-of-pocket costs for the
services when furnished by an in-network provider.”

Some health insurance companies simply won’t contract with electrologists and claim that they’re meeting client needs anyway (I’ll very specifically call out Trillium for doing this). If the health insurance company has no in-network electrolysis providers available, they must allow you to receive coverage for out-of-network services. There are licensed electrologists currently accepting clients in Portland. They have no excuse.