The transgender benefit provides coverage for the treatment of gender dysphoria, formerly called gender identity disorder. Benefits are provided for medically necessary surgical services, including facility and anesthesia fees.
Coverage for prescription drugs and mental health services you receive as you prepare for gender affirming surgery are covered by your plan's prescription drug and mental health benefits.
Coverage and requirements can vary by plan. Sign into your online account to read your benefit booklet to confirm benefits and coverage. If your benefit booklet doesn't include specific requirements, please call customer service to confirm your benefits.
Pre-service review is strongly recommended, so you can be sure what your specific plan covers and avoid surprise bills. Your in-network doctor can request this on your behalf. If your gender affirming surgery is approved, your plan's surgical copay and deductible requirements apply.
To start gender transition, we recommend researching gender affirming clinics to find an experienced surgeon. We do not have a list of specific doctors who specialize in gender treatment, but we can verify the contracting status of a provider if you let us know the full name, address and tax identification of the doctor you select. You can search using the online Find a Doctor tool.
It's common to travel for gender affirming surgery; however your plan doesn't cover travel expenses. If you elect to travel, doctors contracted with Premera Blue Cross or another Blue Cross Blue Shield plan will submit claims to us for you.
If your doctor or facility is out of network, you may submit a claim form to us. Please make sure you have all the procedure and diagnosis codes, as well as costs for each procedure, and medical records. This will ensure timely and accurate processing of your claims.
Before gender transition, you still need to get the medical care recommended for the gender you were born with. After you transition, work with your provider to ensure you get the right checkups for you.
For example, even after surgical transitioning, you could have the same risk of breast cancer.
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