NORTH CAROLINA, USA — The U.S. Court of Appeals for the 4th Circuit has reinstated the State Health Plan’s exclusion of transition-related medical and surgical treatments from coverage, sending the Kadel v. Folwell case back to the district court for further consideration .

The exclusion, which dates to the 1990s, had remained on the plan’s annual list of exclusions but was inactive during ongoing litigation. With the appeals court vacating the district court’s earlier ruling, the exclusion is now active again. The plan notified members of the anticipated action in June.

The reinstated exclusion does not block treatment for infections, injuries, diseases, disorders, or complications caused by or worsened by gender transition procedures. Coverage for psychological assessments and psychoth

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