11/17/2025
The Ninth Circuit has issued a significant decision in C.P. v. Blue Cross Blue Shield of Illinois, a class action challenging categorical exclusions for gender affirming care in employer-provided ERISA plans. The court affirmed that when an insurer accepts federal funding, all of its operations are subject to Section 1557 of the Affordable Care Act, including when it acts as a third-party administrator. It also confirmed that ERISA fiduciary duties do not excuse violations of federal anti-discrimination law. The case now returns to the district court to revisit its s*x discrimination analysis in light of United States v. Skrmetti. Link in comments.