by Jason Coon
Most plans include exclusion lists addressing Gender Transition or Gender Identity services to some extent. Many of those exclusions remain very broad and open ended. Many do not include an exclusion for cross-sex hormones within medical or pharmacy coverage.
Furthermore, some states are beginning to refine what benefits will look like for gender related services. For example, the State of Colorado recently received approval from CMS to include Gender Affirming Care as an essential benefit in health plans. This means that cosmetic surgeries and procedures like eye and lid modifications, face tightening, facial bone remodeling for facial feminization, breast/chest construction and reductions, and laser hair removal will require coverage.
It’s necessary to stay connected to your health plan language now more than ever and to discuss how your self-funded plan remains current and reflects appropriate exclusion language. We offer recommended language for your organizational consideration.
Please connect with Jason Coon to learn more.
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