Gender-Affirming Procedures

This policy covers medically necessary gender-affirming care — including hormone treatment, counseling/psychotherapy, chest and genital reconstruction (e.g., bilateral mastectomy, genital reconstruction), hysterectomy, facial procedures, and other gender-affirming surgeries — for individuals diagnosed with gender dysphoria or gender incongruence. Coverage is contingent on meeting documented eligibility and procedure-specific criteria (diagnostic features, capacity for informed consent, documented provider competency), benefit-plan provisions, age-specific prerequisites (additional requirements for <18 such as emotional/cognitive maturity, Tanner stage ≥2, and fertility counseling), typical hormone-therapy timelines (commonly 6–12 months unless declined or contraindicated), and excludes purely cosmetic procedures and cases for intersex individuals; detransition procedures are reviewed case-by-case.

"Hormone treatment for gender affirmation when medically necessary."