Health care coverage: nondiscrimination

The law expressly protects people from health coverage discrimination based on race, color, national origin, age, disability, or sex, including gender identity and sexual orientation. It also prohibits discriminatory exclusions or restrictions on gender-affirming care and requires disability coverage to be administered in an appropriately integrated setting.

What the law does ​

• Prohibits licensed health plans and insurers from denying enrollment, benefits, claims, renewals, or coverage, or imposing extra cost sharing or restrictions, based on protected characteristics.
• Defines sex discrimination to include discrimination based on intersex traits, pregnancy or related conditions, sexual orientation, gender identity, and sex stereotypes.
• Bars categorical exclusions of gender-transition or gender-affirming care and discriminatory limits on services that would otherwise be covered.
• Bars discriminatory marketing, benefit designs, and sex-based policies that cause more than minimal harm or prevent participation consistent with a person's gender identity.
• Requires coverage documents to state the nondiscrimination policy and explain how to file a discrimination grievance online or by phone.
• Allows plans and insurers to deny or limit services for legitimate, nondiscriminatory reasons, including clinical inappropriateness, coverage requirements, or reasonable medical-management rules.

Who it affects ​

• Subscribers, enrollees, policyholders, and insured people in California-licensed health plans and insurance policies.
• People who are transgender, gender diverse, intersex, pregnant, disabled, LGBTQ+, or otherwise protected from coverage discrimination.
• California-licensed health care service plans and health insurers.

Context ​

The Department of Managed Health Care regulates health care service plans, and the California Department of Insurance regulates health insurers.