Common use of Breast Surgery Clause in Contracts

Breast Surgery. The Insured must provide documentation in the form of a written psychological assessment from at least one qualified behavioral health provider experienced in treating Gender Dysphoria. The assessment must document that the Insured meets all of the following criteria:  Has persistent, well-documented Gender Dysphoria;  Has the capacity to make a fully informed decision and to consent for treatment;  Must be 18 years or older; and  If significant medical or mental health concerns are present, they must be reasonably well controlled.

Appears in 5 contracts

Samples: Epo Agreement of Coverage, Epo Agreement of Coverage, Group Health Insurance Certificate of Coverage

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Breast Surgery. The Insured must provide documentation in the form of a written psychological assessment from at least one qualified behavioral health provider experienced in treating Gender Dysphoria. The assessment must document that the Insured meets all of the following criteria:  Has persistent, well-documented Gender Dysphoria;  Has the capacity to make a fully informed decision and to consent for treatment;  Must be 18 years or older; and  If significant medical or mental health concerns are present, they must be reasonably well controlled.:

Appears in 2 contracts

Samples: Agreement of Coverage, Group Health Insurance Certificate of Coverage

Breast Surgery. The Insured Member must provide documentation in the form of a written psychological assessment from at least one qualified behavioral health provider experienced in treating Gender Dysphoria. The assessment must document that the Insured Member meets all of the following criteria:  Has persistent, well-documented Gender Dysphoria;  Has the capacity to make a fully informed decision and to consent for treatment;  Must be 18 years or older; and  If significant medical or mental health concerns are present, they must be reasonably well controlled.

Appears in 1 contract

Samples: Agreement of Coverage

Breast Surgery. The Insured must provide documentation in the form of a written psychological assessment from at least one qualified behavioral health provider experienced in treating Gender Dysphoria. The assessment must document that the Insured meets all of the following criteria: Has persistent, well-documented Gender Dysphoria; Has the capacity to make a fully informed decision and to consent for treatment; Must be 18 years or older; and If significant medical or mental health concerns are present, they must be reasonably well controlled.

Appears in 1 contract

Samples: Group Health Insurance Certificate of Coverage

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Breast Surgery. The Insured must provide documentation in the form of formof a written psychological assessment from at fromat least one qualified behavioral health provider experienced in treating Gender Dysphoria. The assessment must document that the Insured meets all of the following criteria: Has persistent, well-documented Gender Dysphoria; Has the capacity to make a fully informed decision and to consent for treatment; Must be 18 years or older; and If significant medical or mental health concerns are present, they must be reasonably well controlled.

Appears in 1 contract

Samples: Group Health Insurance Certificate of Coverage

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