In June 2020, the U.S. Supreme Court's decision in Bostock v. Clayton County established that employers cannot discriminate against employees based on their gender identity under Title VII of the Civil Rights Act of 1964. Since then, many employers have taken preventative measures to ensure compliance by updating employee handbooks and policies including those involving pronouns, dress codes and bathroom or locker room usage.

However, the Bostock ruling extends beyond workplace conduct, harassment and employment issues like hiring or firing. It affects the intricate terms of health insurance plans, such as the inclusion or exclusion of gender-affirming physical, mental or other health care services administered or prescribed to treat gender dysphoria or related diagnoses. Such care may include puberty-delaying medication, hormone replacement therapy, "sex reassignment" surgery or other treatments.