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CMS Specifies Issuer Obligations to Offer Coverage Options to Same Sex Spouses


March 2014

The Centers for Medicare & Medicaid Services (CMS) recently offered guidance in the form of a Q&A to insurance issuers regarding their obligations to same sex spouses when offering health insurance plans in the group or individual markets (including plans offered on the ACA healthcare exchanges). CMS issued regulations in February 2013 that require issuers to guarantee the availability of coverage; these regulations further clarified that certain discriminatory marketing practices or benefit designs will not comply with the guaranteed availability requirement. The Q&A specifies that health insurance issuer marketing practices or benefit designs that discriminate against an individual’s sexual orientation would violate the guaranteed availability requirement. Accordingly, a health insurance offering that provides coverage for opposite sex spouses would violate the guaranteed availability requirement if such coverage excluded same sex spouses who had married in a jurisdiction that recognizes same sex marriage.