Plan Website: Wisconsin State Employees' Health Plan
Administrator: Wisconsin Public Employees Health Insurance Program
This plan is self-funded.
This plan has no exclusion.
Based on a permanent injunction issued on October 11, 2018 and the summary judgment decision issued on September 18, 2018 by the federal district court for the Western District of Wisconsin, all procedures, services, and supplies related to surgery and sex hormones associated with gender reassignment should be reviewed by the health plans for medical necessity. “Medically necessary” is defined in the Section I., Definitions of the Uniform Benefits section of the State of Wisconsin Group Health Insurance Program Agreement. (p. 35 - 36)
In Boyden v. State of Wisconsin the ACLU successfully challenged the exclusion of transgender-related care under the Wisconsin state employee health plan.
Boyden v. State of Wisconsin, No. 17-CV-264-WMC (D. Wisc. Jun. 7, 2019), ECF No. 261 (awarding $780,500 in damages to two plaintiffs, including for reimbursement of facial reassignment surgery).