Health insurers cannot limit preventive services based on a person's birth gender, gender identity or recorded gender, the Obama administration said Tuesday, addressing claims of discrimination against transgender people.

The clarification was included among other guidelines that the Health and Human Services Department released in response to confusion among insurers and consumers. It said issuers should cover the preventative services an individual's provider deems appropriate.

Historically, insurance companies have categorized services as being for men or women and denied screening, tests, and treatment coverage for people whose gender listed on their coverage record is not the same as the gender for which the services were designed.

For example, a transgender woman over the age of 50 who has transitioned from male to female might still have her gender listed as male on her insurance record. Although mammograms are recommended for a woman her age, an insurance still might not cover the service based on the insurance record, said Harper Jean Tobin, policy director at the National Center for Transgender Equality.

"Regardless of your gender assigned at birth, the gender listed in your insurance record of your gender identity, you still have the body parts that you have and they still need medical care. What HHS is saying here is that people need access to preventive services that are appropriate for them," Tobin said. "It should be based on what body parts do they have and what medical needs do they have."

Almost 100 issuers in 12 states offers coverage that does not comply with non-discrimination provisions in the Affordable Care Act, according to a National Women's Law Center report released last month. Examples of noncompliance include violating prohibitions on sex discrimination and excluding care for transgender people, among other things.

The HHS guidance does not address coverage of hormone treatment, psychotherapy, or surgery for transgender people. While those services have historically been excluded from coverage, a minority of states have reversed the exclusions.

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