In May 2016, the U.S. Department of Health & Human Services Office for Civil Rights issued its final rule regarding non-discrimination as it pertains to transgender services. The new rule requires that insurers provide coverage for medically necessary services regardless of an individual?s self-identified gender. As a result, insurers may not exclude services related to transgender benefit coverage, including transgender surgery.

Accordingly, beginning January 1, 2017, AmeriHealth will remove exclusions of coverage for transgender surgery for all plans. Note: For group plans, coverage will be provided on their renewal date in 2017. This service will be available to members under the terms of their AmeriHealth insurance plan.

AmeriHealth is updating Medical Policy #11.09.02c: Treatment of Gender Dysphoria to reflect this change, which will be posted as a Notification on November 1, 2016, and will become effective January 1, 2017.

To view the Notification for this policy, visit our Medical Policy Portal and select Accept and Go to Medical Policy Online. Then select Commercial under Active Notifications.