So uhh, let's break this down.

The ruling is based directly on Bostock's sex protections. It means that even plans which are fully paid by the employer would be bound by this, as long as whichever company runs the processing takes even one red cent of federal money.

The ruling will definitely be appealed to the SC. But unless Roberts and Gorsuch reverse their positions in Bostock, I think this one stands.

Overwhelmingly, fully funded insurance plans are administered by big corps, like BCBS or Aetna. All of those companies take federal $.

All of them. Because of the Health Insurance Marketplace.

And once the standard is on medical necessity, the definitive worldwide standards is WPATH SoC8. Which, if you want to check coverage, I did a write up a few months ago (https://stainedglasswoman.substack.com/p/what-do-wpath-standards-of-care-8).

Or you can check this list. **Everything's** on it.