![]() and his parents, but also for the hundreds of transgender people who were, are, or were likely to be denied medically necessary gender-affirming care because of BCBSIL’s administration of approximately 400 ERISA health plans with these unlawful exclusions. “The court’s decision not only establishes that categorical exclusions for coverage of gender-affirming care are unlawful discrimination, but it also concludes that health insurers who receive federal funds and act as third-party administrators have an independent duty to not administer discriminatory ERISA health plans,” said Omar Gonzalez-Pagan, Counsel and Health Care Strategist for Lambda Legal. District Court for the Western District of Washington, argued that BCBSIL’s administration of the exclusion is in direct violation of the health nondiscrimination law enacted as part of the Affordable Care Act, known as Section 1557. The ruling came in a class action lawsuit filed by Lambda Legal and Sirianni Youtz Spoonemore Hamburger PLLC challenging BCBSIL’s administration of the discriminatory blanket exclusion on behalf of a 17-year-old transgender young man, C.P., and his parents. This follows the district court’s November 9, 2022, order certifying a class comprised of individuals who were, are, or will be denied pre-authorization or coverage of gender-affirming care as a result of BCBSIL’s administration of categorical exclusions of such care. In 2021, BCBS of Michigan took over sole ownership of the company, which provides tools to support a wide range of insurance functions including membership management, claims processing and customer service.A federal district judge today ruled that Blue Cross Blue Shield of Illinois (BCBSIL) cannot exclude coverage for medically necessary gender-affirming care in its administration of employer-provided ERISA health plans. “We would not have been able to do that without their partnership and help,” George said.īCBS of Vermont had also been a co-owner of NASCO, a healthcare information technology firm, with BCBS of Michigan and four other Blue insurers. Seven of 12 current board members would stay on, with the five seats coming open to be filled with executives and board members from BCBS of Michigan, George said.īCBS of Vermont first partnered with its Michigan counterpart to roll out its Vermont Blue Advantage plan through the Medicare Part C program, also known as Medicare Advantage, in late 2020. ![]() Its board of directors would be reconstituted, though Vermont members would retain a majority. All premium dollars and reserve funds would remain in state to pay claims and fund operations. ![]() The Vermont insurer covers around 200,000 people.īlue Cross and Blue Shield of Vermont would keep its name and remain headquartered in Berlin with the same leadership team and workforce. BCBS of Michigan is that state’s largest insurer and provides coverage for around 5.2 million people, around 3.9 million of them in Michigan. The affiliation allows Vermonters to take advantage of the resources available to BCBS of Michigan because of the latter’s scale. “Through this partnership, we will access advanced technology and capabilities and new program capacity for our members and customers without having to build or purchase them ourselves,” he said in an interview. The Vermont organization’s decision to affiliate with its Detroit-based counterpart, announced Monday, would give the state’s largest provider of health insurance access to a more sophisticated array of digital technology than it could afford on its own, according to BCBS of Vermont CEO Don George. File photo by Andrew Stein/VTDiggerīlue Cross and Blue Shield of Vermont is seeking to become part of the Blue Cross Blue Shield of Michigan “family of companies.” Blue Cross Blue Shield of Vermont headquarters in Berlin.
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