LGBTQ Legal Issues

Employer health plan's exclusion for gender-affirming care violates Title VII, 11th Circuit rules

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A federal appeals court has ruled that a health insurance provider can be liable for denying gender-affirming care to transgender people under Title VII of the Civil Rights Act. (Image from Shutterstock)

A federal appeals court has ruled that a health insurance provider can be liable for denying gender-affirming care to transgender people under Title VII of the Civil Rights Act.

The 11th U.S. Circuit Court of Appeals at Atlanta ruled for Georgia transgender sheriff’s deputy Anna Lange in a May 13 decision, report Law360 and the Atlanta Journal-Constitution.

Lange was represented by the Transgender Legal Defense and Education Fund, according to a May 13 press release.

The decision is the first time that a federal appeals court has held that employers can’t discriminate against transgender people in employee health plans, according to the Transgender Legal Defense and Education Fund.

In another decision issued April 29, a different federal appeals court ruled that a ban on gender-affirming care by state-operated health care plans in North Carolina and West Virginia violated the equal protection clause. The 4th Circuit at Richmond, Virginia, said the health plans discriminated on the basis of sex and gender.

In the Georgia case, Lange’s health care provider had determined that a vaginoplasty was medically necessary after she came out as transgender in 2017, 11 years after she began work for the Houston County, Georgia, sheriff’s office.

The employee health plan refused to pay for the surgery under an exclusion for sex-change drugs, services and supplies.

A trial judge granted summary judgment to Lange on the Title VII claim, and jurors awarded $60,000 in damages. The judge also issued an injunction preventing the sheriff’s office from enforcing the ban on gender-affirming treatment.

The 11th Circuit affirmed.

“Houston County deprived Lange of a benefit or privilege of her employment by reason of her nonconforming traits, thereby unlawfully punishing her for her gender nonconformity,” wrote Judge Charles R. Wilson for the majority.

Wilson is an appointee of former President Bill Clinton. Judge Andrew L. Brasher, an appointee of former President Donald Trump, dissented.

“The employer-provided health insurance plan here does not deny coverage to anyone because he or she is transgender,” Brasher wrote. “The alleged problem with this plan is that it excludes coverage for sex change surgeries, not that it denies coverage to transgender people. On the face of this policy, it doesn’t treat anyone differently based on sex, gender nonconformity or transgender status.”

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