Harrisburg, PA – In honor of LGBTQ+ Pride Month, celebrated nationally in June, Pennsylvania Insurance Commissioner Michael Humphreys is highlighting the Pennsylvania Insurance Department's (PID) efforts to assure that health insurers are covering benefits fairly and providing access to relevant care for the LGBTQ+ community. PID is focused on enhancing its compliance review of 2024 health plan filings to verify that benefits are being covered without discrimination or stigma for all individuals – no matter who they love or how they identify.
"Pennsylvania's LGBTQ+ communities should have access to quality care and treatment free from discrimination, without having to worry about their health plans denying benefits because of how they live their lives," said Humphreys. "Governor Josh Shapiro is committed to making sure that all Pennsylvanians have equal access to health care services that are vital for their communities, and to that end, PID is examining the health plans within its regulatory authority to make certain that insurance coverage in Pennsylvania is equitable for all."
The Department's Office of Insurance Product Regulation has started its review of health plans for Plan Year 2024 and is examining various aspects of plans for the individual, small, and large group markets to confirm that benefits are offered in a non-discriminatory manner. Culturally relevant treatment for the LGBTQ+ community being reviewed include:
- Infertility benefits and the implication for same-sex couples of plan language requiring failed attempts at natural conception
- Application language, to encourage any demographic questions to allow non-binary and "other" response options
- BRCA1 and BRCA2 counseling and testing (the genes most commonly affected in hereditary breast and ovarian cancer) and breast screening coverage language, to ensure plans do not discriminate against non-binary or transgender persons who may have been assigned female at birth but do not identify as female
Commissioner Humphreys also noted that HIV pre-exposure prophylaxis, or PrEP, medication for HIV prevention, is an important prevention tool for the LGBTQ+ community and should in most cases be covered at zero cost to the consumer under the Affordable Care Act.
"The federal government requires most insurers to cover HIV PrEP medication at zero cost to the consumer, if the consumer is at high risk of HIV acquisition," added Humphreys. "Almost all health insurance plans under PID's jurisdiction should be following the requirements to cover PrEP and related services without cost sharing. Nobody in Pennsylvania should ever have to forgo medically necessary preventive medication or services because of cost."
"Zero-cost" means that the consumer will not be charged an out-of-pocket copayment, deductible, or coinsurance for these drugs. Tests, doctor visits, and other services directly related to obtaining PrEP and included in the PrEP billing, should also be covered with no out-of-pocket cost to the consumer.
Any consumer who has received HIV PrEP medication and was charged a copayment, coinsurance, or deductible should contact their health insurer to request a refund. The number for the insurer can usually be found on the back of the health insurance card. Consumers are also encouraged to contact the Pennsylvania Insurance Department if they have any questions on coverage of HIV PrEP medication or need assistance.
The Shapiro Administration has prioritized providing real freedom for all Pennsylvanians, regardless of where they come from, what they look like, or who they love. In his first six months in office, Governor Shapiro has called for the passage of the Fairness Act to ensure equal protection under the law and became the first Pennsylvania governor to march in the Pittsburgh Pride Parade. This Pride Month, the Insurance Department stands with the Shapiro Administration and reaffirms its commitment to ensuring that health insurance is affordable and effective for all.
Consumers who have questions on coverage of HIV PrEP medication, or believe their health plan may be discriminating against them because they are an LGBTQ+ individual, should contact the Insurance Department online at insurance.pa.gov or call the Department's Consumer Services Bureau at 1-877-881-6388.