On September 9, 2025, the U.S. Court of Appeals for the Eleventh Circuit, sitting en banc, ruled that a county health insurance plan’s exclusion denying coverage for gender-affirming surgery did not violate Title VII of the Civil Rights Act of 1964 on its face. The ruling overturned a district court’s decision that had concluded the plan’s exclusion was facially discriminatory under Title VII and had harmed a transgender county sheriff’s deputy.

• The Eleventh Circuit ruled that a county health insurance plan’s exclusion of gender-affirming surgery did not violate Title VII, interpreting protections for LGBTQ+ individuals narrowly.
• The court concluded that the plan’s policy was not facially discriminatory since it applied equally to all employees regardless of sex.
• A dissenting opinion argued that the ruling improperly relied on a precedent that should not apply to Title VII discrimination cases involving medical conditions that impact employees differently based on sex.

In Lange v. Houston County, Georgia, a transgender woman who served as a deputy in the Houston County Sheriff’s Office alleged that the county health insurance plan violated Title VII on its face because it discriminated on the basis of sex and penalized individuals for being transgender after being denied health insurance coverage for a gender-affirming procedure under an exclusion for “sex change surgery.”

However, in a divided en banc opinion, the Eleventh Circuit rejected such arguments, finding that...

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