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
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
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