Gender Assignment Surgery and Gender Reassignment Surgery with Related Services

This policy covers gender assignment and gender reassignment surgeries and related services—including genital and chest reconstructive procedures, hormone therapy, and psychological services—for patients with ambiguous genitalia at birth (as reconstructive care) and for adolescents and adults with persistent, well‑documented gender dysphoria. Coverage is contingent on meeting medical‑necessity criteria (diagnosis of persistent gender dysphoria, capacity to consent), required referrals from a qualified mental health professional prior to hormonal therapy or chest surgery, specified hormone‑therapy/stability timelines for adolescents and certain procedures (e.g., generally ≥12 months on hormones for adolescents and 1 year of testosterone before FtM chest surgery), and is subject to member benefit contracts, state laws, and other documentation requirements; services not meeting these criteria are not covered.

"Gender assignment surgery"