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November 2016

Blue Cross to cover medical and pharmaceutical services for gender transition

Blue Cross Blue Shield of Michigan already provides gender transition benefits to many of its groups. Starting on Jan. 1, 2017, Blue Cross will extend these benefits to individuals and groups that currently have none or only some of them.

New benefits may include:

  • Gender reassignment surgery
  • Hormone therapy
  • Psychotherapy and counseling
  • Mastectomy for female to male transitions

Some surgical procedures will continue to require preauthorization. Always check a member’s eligibility and benefits.

Why are benefits for gender transition changing?

We’re changing our gender transition benefits in response to a final rule under Section 1557 of the Affordable Care Act. The rule, issued this year by the Department of Health and Human Services, prohibits discrimination on the basis of race, color, national origin, sex, age or disability in health programs or activities that receive federal financial assistance.

According to the rule, discrimination on the basis of sex includes discrimination based on gender identity. Protections for those seeking gender transition services are outlined in the rule.

This is the first time gender transition benefits have been mandated for health care coverage. This rule requires that gender transition benefits be available in health care plans starting on and after Jan. 1, 2017.

How will Blue Cross meet the requirements of the federal rule?

Blue Cross has been working to ensure its members will have access to these services no later than the start of their plan years, beginning on or after Jan. 1, 2017. Blue Cross groups and individuals will receive their enhanced benefits on Jan. 1, 2017, with the exception of NASCO Classic groups, which will receive them at the start of their 2017 plan year.

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2015 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
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