The Transgender Legal Defense and Education Fund has sued the state of Tennessee over the exclusion of transition-related care from the state’s health insurance plan.

In the suit, filed Thursday in U.S. District Court for the Middle District of Tennessee, TLDEF is representing a current participant in the plan and a former one. Gerda Zinner (pictured, left), an academic adviser at the University of Tennessee at Chattanooga, is a trans woman who was denied surgery because the state’s public employee health plan, the State of Tennessee Comprehensive Medical and Hospitalization Program, categorically excludes coverage for transgender-related health care. Story VanNess is a trans woman who was a special education teacher for Knox County Schools for five years, was enrolled in the state’s plan but was also denied coverage for gender-affirming surgery.

The state covers the same procedures for cisgender people to treat injuries, illnesses, or other conditions but excludes them for the purpose of gender transition.

“The only reason the State of Tennessee refuses to provide these women with coverage for medically necessary health care is because they are transgender,” Ezra Cukor, TLDEF staff attorney, said in a press release. “This is clearly unlawful discrimination that jeopardizes the health of hardworking state employees and their families.”

“It took years of careful consideration before I was finally in a position to move forward with surgical care, an important part of my transition,” Zinner said in the release. “Knowing that the only reason I can’t get the care that my doctors and I have decided that I need is because I’m transgender is hurtful and makes me feel second-class.”

“Working with students who have special needs was one of the greatest joys of my life, but it was excruciating to be denied coverage for needed health care simply because I’m transgender,” VanNess added.

The suit argues that Tennessee officials are violating the Equal Protection Clause of the U.S. Constitution, Title IX of the Education Amendments of 1972, and Title VII of the Civil Rights Act of 1964 by unlawfully discriminating based on sex and transgender status.

“Federal laws protect transgender people from workplace discrimination on the basis of sex,” Darren Teshima, partner at Covington & Burling LLP, which is handling the suit with TLDEF and other attorneys, said in the release. “This lawsuit seeks to ensure that the State of Tennessee and its affiliates stop wrongfully excluding medically necessary transition-related care from their employee health care plans. Covington is very proud to partner with our co-counsel and clients in this important work.”