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CareFirst BlueCross BlueShield, the state's largest insurer, is expanding coverage so gender reassignment surgery is covered for transgender customers in Maryland.

The insurer is eliminating language from its policies that denied coverage for any "treatment leading to or in connection with transsexualism, or sex changes or modifications, including, but not limited to surgery."

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CareFirst worked with the lesbian, gay, bisexual and transgender community to broaden its coverage after the group FreeState Legal filed an insurance discrimination claim against the insurer on behalf of a client that was denied coverage for transition-related procedures.

The change was announced Thursday by the legal advocacy group. Officials with the insurer declined to comment Thursday.

The new policy does not necessarily extend to CareFirst plans offered by large employers, who decide their own coverage.

In ending discrimination against patients based on sexual orientation or gender identity, CareFirst joins the state of Maryland, which changed its policies for state employees last year and for Medicaid in January.

"This is very significant for the transgender community in Maryland," said Patrick Paschall, a spokesman for FreeState Legal.

The actions are the latest examples of greater recognition of transgender rights after the state's passage of the Fairness for All Marylanders Act of 2013, which banned transgender discrimination in employment and other public accommodations. FreeState Legal had argued that while the fairness act did not specifically address health insurance, it signaled that the state would not tolerate gender identity discrimination in any form.

The decision to expand coverage under Medicaid was first announced during the end of Gov. Martin O'Malley's term, but put under review when current Gov. Larry Hogan, who agreed to the expansion after consulting with the Department of Health and Mental Hygiene.

A non-discrimination clause in the Affordable Care Act required the state to provide transgender patients with coverage for reassignment surgery and other medical care, said Shannon M. McMahon, the state's deputy secretary of health care financing.

The expansion of the Medicaid and CareFirst coverage could have an impact on at least 5,000 people, FreeState said. The state estimates that at least 20 people could get gender reassignment surgery in the first year.

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