C.F.R. » Title 45 » SUBCHAPTER A—GENERAL ADMINISTRATION › PART 92—NONDISCRIMINATION IN HEALTH PROGRAMS OR ACTIVITIES › Subpart C—Specific Applications to Health Programs and Activities

45 C.F.R. § 92.207

Nondiscrimination in health insurance coverage and other health-related coverage

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(a) A covered entity must not, in providing or administering health insurance coverage or other health-related coverage, discriminate on the basis of race, color, national origin, sex, age, disability, or any combination thereof.

(b) A covered entity must not, in providing or administering health insurance coverage or other health-related coverage:

(1) Deny, cancel, limit, or refuse to issue or renew health insurance coverage or other health-related coverage, or deny or limit coverage of a claim, or impose additional cost sharing or other limitations or restrictions on coverage, on the basis of race, color, national origin, sex, age, disability, or any combination thereof;

(2) Have or implement marketing practices or benefit designs that discriminate on the basis of race, color, national origin, sex, age, disability, or any combination thereof, in health insurance coverage or other health-related coverage;

(3) Deny or limit coverage, deny or limit coverage of a claim, or impose additional cost sharing or other limitations or restrictions on coverage, to an individual based upon the individual's sex assigned at birth, gender identity, or gender otherwise recorded;

(4) Have or implement a categorical coverage exclusion or limitation for all health services related to gender transition or other gender-affirming care;

(5) Otherwise deny or limit coverage, deny or limit coverage of a claim, or impose additional cost sharing or other limitations or restrictions on coverage, for specific health services related to gender transition or other gender-affirming care if such denial, limitation, or restriction results in discrimination on the basis of sex; or

(6) Have or implement benefit designs that do not provide or administer health insurance coverage or other health-related coverage in the most integrated setting appropriate to the needs of qualified individuals with disabilities, including practices that result in the serious risk of institutionalization or segregation.

(c) Nothing in this section requires coverage of any health service where the covered entity has a legitimate, nondiscriminatory reason for denying or limiting coverage of the health service or determining that such health service fails to meet applicable coverage requirements, including reasonable medical management techniques such as medical necessity requirements. Such coverage denial or limitation must not be based on unlawful animus or bias, or constitute a pretext for discrimination. Nothing in this section is intended to preclude a covered entity from availing itself of protections described in §§ 92.3 and 92.302.

(d) The enumeration of specific forms of discrimination in paragraph (b) of this section does not limit the general applicability of the prohibition in paragraph (a) of this section.

Notes of Decisions
Cited in 10 cases (4 in the last 5 years), 2016–2025 · leading case: Franciscan All., Inc. v. Burwell, 227 F. Supp. 3d 660 (N.D. Tex. 2016).
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Franciscan All., Inc. v. Burwell, 227 F. Supp. 3d 660 (N.D. Tex. 2016). · cites it 5× “” 45 C.F.R. § 92.207 (b). The Rule declares that categorizations of all transition-related treatment as cosmetic or experimental are now “outdated and not based on current standards of care.”
Andrea Schmitt v. Kaiser Found. Health Plan, 965 F.3d 945 (9th Cir. 2020). “” 45 C.F.R. § 92.207 (b)(4). Kaiser assumes that the agency’s inclusion of a regulation specific to gender dysphoria signals the agency’s implicit unwillingness to prohibit similar categorical exclusions for treatments of other conditions.”
& v. Essentia Health, 342 F. Supp. 3d 947 (D. Me. 2018). “; see also 45 C.F.R. § 92.207 (b)(4), 92.4. The Franciscan Alliance court concluded that the regulations exceeded DHHS's authority and therefore violated the Administrative Procedures Act.”
L.B. v. Premera Blue Cross (W.D. Wash. 2025). · cites it 3× “37160 , 2020 WL 3298450 (June 19, 2020) (repealing 15 45 C.F.R. § 92.207 ); Nondiscrimination in Health Programs and Activities, 89 Fed.”
Boston All. of Gay, Lesbian, Bisexual & Transgender Youth (BAGLY) v. United States Dep't of Health & Human Servs. (D. Mass. 2021). · cites it 2× “at 31,472 (formerly codified at 45 C.F.R. § 92.207 (b)(4)). Under the Rule, a plaintiff bringing a claim under § 1557 can invoke the enforcement mechanism from any of the referenced civil rights statutes, regardless of the type of discrimination alleged.”
Whitman-Walker Clinic, Inc. v. U.S. Dep't of Health & Human Servs. (D.D.C. 2020). “at 31 ,471–72 (formerly codified at 45 C.F.R. § 92.207 (b)(4)). It also required health-care providers and other covered entities to post notices and short, written “taglines” — in fifteen different languages in certain significant publications and in conspicuous physical…”
Tovar v. Essentia Health (D. Minnesota 2018). “; see also 45 C.F.R. § 92.207 (b)(4), 92.4. The Franciscan Alliance court concluded that the regulations exceeded DHHS’s authority and therefore violated the Administrative Procedures Act.”
North Dakota, State of v. Burwell (D.N.D. 2021). “at 31,471-72 (formerly codified at 45 C.F.R. § 92.207 (b)(4)-(5)). Put differently, the 2016 Rule prohibited covered insurers and third-party administrators3 (“TPAs”) from offering or administering health plans with gender-transition exclusions.”
Asapansa-Johnson Walker v. Azar II (E.D.N.Y 2020). “ 45 C.F.R. § 92.207 , which dealt with discrimination in health insurance.”
State Of Texas v. Becerra (E.D. Tex. 2024). “at 37,701 , to be codified at 45 C.F.R. § 92.207 . Specifically, this section prohibits any “categorical coverage exclusion or limitation for all health services related to gender transition or other gender-affirming care” and any denial or limitation of a claim for “specific…”
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