June 03, 2025
On May 15, 2025, the Oregon DOI issued Bulletin No. DFR 2025-4 regarding health benefit plan coverage of gender-affirming treatment under Oregon Revised Statutes (ORS) 743A.325 and Oregon Administrative Rule (OAR) 836-053-0441.
The bulletin provides supplemental guidance for health benefit plans regarding coverage of gender-affirming treatment, including WPATH-8 as a minimum standard for coverage, network adequacy, and “detransition services,” where clinical treatments are intended to reverse the effect of prior gender-affirming treatments. The bulletin also indicates that where gender-affirming care items and services are medically necessary (and prescribed according to a different accepted standard of care), carriers are expected to cover those items and services. The bulletin is effective May 15, 2025, and supersedes a prior bulletin (DFR2024-2).
Employers with plans governed by state laws should be aware of these mandates and can contact their carrier for further details.
DFR 2025-4 Health benefit plan coverage of gender-affirming treatment under ORS 743A.325 and OAR 836-053-0441
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