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, Independence 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 Independence insurance plan.
Independence is updating the following policies to reflect this change:
- Commercial: #11.09.02c: Treatment of Gender Dysphoria
- Medicare Advantage: #MA11.106b: Treatment of Gender
Dysphoria
These policies will be posted as Notifications on November 1, 2016, and will
become effective January 1, 2017.
To view the Notifications for these policies, visit our Medical Policy Portal and select
Accept
and Go to Medical Policy Online. Then select Commercial or
Medicare Advantage under Active Notifications.