Gender Affirming Services. This plan covers gender affirming services as described below. The amount you pay depends on the covered healthcare service you receive, as indicated in the Summary of Medical Benefits and the Summary of Pharmacy Benefits. • Prescription drug services including but not limited to: o Gender affirming therapy services provided as a pharmacy benefit or a medical prescription drug benefit. o Puberty suppressing medications are covered as a medical prescription drug benefit. • Surgical services as indicated below: o Abdominoplasty and liposuction (suction-assisted lipectomy) o Blepharoplasty o Breast enlargement, including augmentation mammaplasty and breast implants, o Brow lift, forehead lift, brow ptosis surgery o Cheek, chin, and nose implants o Clitoroplasty (creation of clitoris) o Face lift or neck tightening o Facial bone reduction or remodeling for facial feminization including thyroid cartilage reduction/reduction thyroid chondroplasty/trachea shave (Xxxxx Apple reduction) o Hysterectomy (removal of uterus) o Labiaplasty (creation of labia) o Lip augmentation or lip reduction o Mastopexy o Metoidioplasty (creation of penis, using clitoris), penile prosthesis o Orchiectomy (removal of testicles) o Penectomy (removal of penis) o Phalloplasty (creation of penis) o Rhinoplasty o Salpingo-oophorectomy (removal of fallopian tubes and ovaries) o Scrotoplasty (creation of scrotum) o Subcutaneous injections of filling materials or neurotoxins o Testicular prosthesis o Urethroplasty (reconstruction of female or male urethra) o Vaginectomy (removal of vagina) o Vaginoplasty (creation of vagina) o Voice modification surgery, voice lessons, and voice therapy o Vulvectomy (removal of vulva). Preauthorization may be required for gender affirming surgical services.
Appears in 9 contracts
Samples: Subscriber Agreement, Subscriber Agreement, Subscriber Agreement
