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Coverage for transgender services

October 31, 2016

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.


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