September 9, 2025
Overview:
On September 9, 2025, the Eleventh Circuit Appeals Court reversed the prior decisions in Lange v. Houston County, Georgia, that determined the exclusion of gender transition surgery from coverage did not facially violate Title VII civil rights. The 11 to 5 en banc decision relied heavily on the recent U.S. Supreme Court decision in United States v. Skrmetti.
Who This Applies To: Employers with group medical plans who wish to restrict or exclude certain gender dysphoria treatment and drugs.
Go Deeper:
When group health plans wish to restrict or exclude certain treatments for gender dysphoria, there is always a risk that such a policy discriminates in violation of Title VII, which prohibits employers from discriminating based on sex in all matters of employment, including benefits. Many courts interpret this as prohibiting such a restriction or exclusion as discrimination. This reversal does not necessarily settle the matter and may be appealed to the U.S. Supreme Court.
In addition to Title VII civil rights, there have been varying legal interpretations of whether health plan restrictions or exclusions for gender dysphoria treatment violate ยง1557 and/or the Mental Health Parity and Addiction Equity Act (MHPAEA). The rules under both federal laws have fluctuated yet again under the new administration, but Title VII has long presented itself as the main consideration for employers on this issue.
Practical Impact to Employers:
Any employer wishing to impose such a restriction or exclusion should always work with legal counsel who agrees to represent them in court if an employee challenges their plan. As this appeal ruling and a similar ruling for the Christian Employers Alliance have shown, this is not a settled area of law. So, proceeding with a restriction or exclusion for gender dysphoria treatment is not guaranteed to be supported by the law and should not be done without qualified counsel.