Common use of Genital Surgery Clause in Contracts

Genital Surgery. The Member must provide documentation in the form of a written psychological assessment from at least two qualified behavioral health providers experienced in treating Gender Dysphoria, who have independently assessed the Member. The assessment must document that the 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 18 years or older;  If significant medical or mental health concerns are present, they must be reasonably well controlled;  Complete at least 12 months of successful continuous full-time real-life experience in the desired gender; and  Complete 12 months of continuous cross-sex hormone therapy appropriate for the desired gender (unless medically contraindicated). HPN makes no representation or warranty as to the medical competence or ability of any Gender Dysphoria Treatment Center/Facility or its respective staff or Physicians. HPN shall have no liability or responsibility, either direct, indirect, vicarious or otherwise, or any actions or inactions, whether negligent or otherwise, on the part of any Gender Dysphoria Treatment Center/Facility or its respective staff or Physicians. Genetic Disease Testing Services Covered Services include Prior Authorized Medically Necessary Genetic Disease Testing, when:  such testing is prescribed following the Member’s history, physical examination and pedigree analysis, genetic counseling, and completion of conventional diagnostic studies, and a definitive diagnosis remains uncertain and a genetic disease diagnosis is suspected, and;  the Member displays clinical features, or is at direct risk of inheriting the mutation in question (pre-symptomatic); and  the result of the test will directly impact the treatment being delivered to the Member. Healthcare Facility Services Covered Services include the following accommodations, services and supplies received during an admission to a Hospital, Ambulatory Surgical Facility, Skilled Nursing Facility, Residential Treatment Center or Hospice Care Facility. Accommodations:  Semiprivate (or multibed unit) room, including bed, board, and general nursing care.  Private room including bed, board, and general nursing care, but only when treatment of the Member's condition requires a private room. The semiprivate room rate will be allowed toward the private room rate when a Member receives private room accommodations for any reason other than Medical Necessity.  Inpatient accommodations provided in connection with the birth of a child shall be provided for a minimum of forty-eight (48) hours following an uncomplicated vaginal delivery or a minimum of ninety-six (96) hours following an uncomplicated delivery by cesarean section. This provision does not require a Member to deliver in a Hospital or other healthcare facility or to remain therein for the minimum number of hours following delivery.  Intensive care unit (including Cardiac Care Unit), including bed, board, general and special nursing care, and ICU equipment.  Observation unit, including bed, board, and general nursing care not to exceed twenty-three (23) hours.

Genital Surgery. The Member must provide documentation in the form of a written psychological assessment from at least two qualified behavioral health providers experienced in treating Gender Dysphoria, who have independently assessed the Member. The assessment must document that the 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 18 years or older;  • If significant medical or mental health concerns are present, they must be reasonably well controlled;  • Complete at least 12 months of successful continuous full-time real-life experience in the desired gender; and  • Complete 12 months of continuous cross-sex hormone therapy appropriate for the desired gender (unless medically contraindicated). HPN makes no representation or warranty as to the medical competence or ability of any Gender Dysphoria Treatment Center/Facility or its respective staff or Physicians. HPN shall have no liability or responsibility, either direct, indirect, vicarious or otherwise, or any actions or inactions, whether negligent or otherwise, on the part of any Gender Dysphoria Treatment Center/Facility or its respective staff or Physicians. Genetic Disease Testing Services Covered Services include Prior Authorized Medically Necessary Genetic Disease Testing, when:  • such testing is prescribed following the Member’s history, physical examination and pedigree analysis, genetic counseling, and completion of conventional diagnostic studies, and a definitive diagnosis remains uncertain and a genetic disease diagnosis is suspected, and;  • the Member displays clinical features, or is at direct risk of inheriting the mutation in question (pre-symptomatic); and  • the result of the test will directly impact the treatment being delivered to the Member. Healthcare Facility Services Covered Services include the following accommodations, services and supplies received during an admission to a Hospital, Ambulatory Surgical Facility, Skilled Nursing Facility, Residential Treatment Center or Hospice Care Facility. Accommodations:  • Semiprivate (or multibed unit) room, including bed, board, and general nursing care.  • Private room including bed, board, and general nursing care, but only when treatment of the Member's condition requires a private room. The semiprivate room rate will be allowed toward the private room rate when a Member receives private room accommodations for any reason other than Medical Necessity.  • Inpatient accommodations provided in connection with the birth of a child shall be provided for a minimum of forty-eight (48) hours following an uncomplicated vaginal delivery or a minimum of ninety-six (96) hours following an uncomplicated delivery by cesarean section. This provision does not require a Member to deliver in a Hospital or other healthcare facility or to remain therein for the minimum number of hours following delivery.  • Intensive care unit (including Cardiac Care Unit), including bed, board, general and special nursing care, and ICU equipment.  • Observation unit, including bed, board, and general nursing care not to exceed twenty-three (23) hours.

Genital Surgery. The Member Insured must provide documentation in the form of a written psychological assessment from at least two qualified behavioral health providers experienced in treating Gender Dysphoria, who have independently assessed the MemberInsured. The assessment must document that the Member Insured meets all of the following criteria:  • Has persistent, well-documented Gender Dysphoria;  • Has the capacity Capacity to make a fully informed decision and to consent for treatment;  • Must 18 years or older;  • If significant medical or mental health concerns are present, they must be reasonably well controlled;  • Complete at least 12 months of successful continuous full-time real-life experience in the desired gender; and  • Complete 12 months of continuous cross-sex hormone therapy appropriate for the desired gender (unless medically contraindicated). HPN SHL makes no representation or warranty as to the medical competence or ability of any Gender Dysphoria Treatment Center/Facility or its respective staff or Physicians. HPN SHL shall have no liability or responsibility, either direct, indirect, vicarious or otherwise, or any actions or inactions, whether negligent or otherwise, on the part of any Gender Dysphoria Treatment Center/Facility or its respective staff or Physicians. Genetic Disease Testing Services Covered Services include Prior Authorized Medically Necessary Genetic Disease Testing, Testing when:  such • Such testing is prescribed following the MemberInsured’s history, physical examination and pedigree analysis, genetic counseling, and completion of conventional diagnostic studies, and a definitive diagnosis remains uncertain and a genetic disease diagnosis is suspected, and;  the Member • The Insured displays clinical features, or is at direct risk of inheriting the mutation in question (pre-symptomaticpresymptomatic); and  the • The result of the test will directly impact the treatment being delivered to the MemberInsured. Healthcare Facility Services Covered Services include the following accommodations, services and supplies received during an admission to a Hospital, Ambulatory Surgical Facility, Skilled Nursing Facility, Residential Treatment Center or Hospice Care Facility. Accommodations:  • Semiprivate (or multibed unit) room, including bed, board, board and general nursing care.  • Private room including bed, board, and general nursing care, but only when treatment of the MemberInsured's condition requires a private room. The semiprivate room rate will be allowed toward the private room rate when a Member an Insured receives private room accommodations for any reason other than Medical Necessity.  • Inpatient accommodations provided in connection with the birth of a child shall be provided for a minimum of forty-eight (48) hours following an uncomplicated vaginal delivery or a minimum of ninety-six (96) hours following an uncomplicated delivery by cesarean section. This provision does not require a Member an Insured to deliver in a Hospital or other healthcare facility or to remain therein for the minimum number of hours following delivery.  • Intensive care unit (including Cardiac Care Unit), including bed, board, general and special nursing care, and ICU equipment.  Agreement of Coverage • Observation unit, including bed, board, and general nursing care not to exceed twenty-three (23) hourshours per day. • Nursery charges for newborns. Services and Supplies. Covered Services and supplies provided by a Hospital, Ambulatory Surgical Facility, Skilled Nursing Facility, Residential Treatment Center or Hospice Care Facility include: • non-surgical Provider visits; • operating, recovery, and treatment rooms and equipment (Hospital and Ambulatory Surgical Facility only); • delivery and labor rooms and equipment (Hospital and Ambulatory Surgical Facility only); • anesthesia materials and anesthesia administration by Hospital staff (Hospital and Ambulatory Surgical Facility only); • clinical pathology and laboratory services and supplies; • services and supplies for diagnostic tests required to diagnose Insured's Illness, Injury or other conditions but only when charges for the services and/or supplies are made by the facility (Hospital, Skilled Nursing Facility and Ambulatory Surgical Facility only); • drugs consumed at the time and place dispensed which have been approved for general marketing in the United States by the Food and Drug Administration (FDA); • dressings, splints, casts and other supplies for medical treatment provided by the Hospital from a central sterile supply department; • oxygen and its administration; • non-replaced blood, blood plasma, blood derivatives, and their administration and processing; • intravenous injections and solutions; • private duty nursing subject to the benefit limitation for such services; • supportive services for a Hospice patient's family, including care for the patient which provides a respite from the stresses and responsibilities that result from the daily care of the patient and bereavement services provided to the family after the death of the patient (Hospice Care Facility only); and • Sterilization procedures.

Genital Surgery. The Member Insured must provide documentation in the form of a written psychological assessment from at least two qualified behavioral health providers experienced in treating Gender Dysphoria, who have independently assessed the MemberInsured. The assessment must document that the Member Insured meets all of the following criteria:  Has persistent, well-documented Gender Dysphoria;  Has the capacity Capacity to make a fully informed decision and to consent for treatment;  Must 18 years or older;  If significant medical or mental health concerns are present, they must be reasonably well controlled;  Complete at least 12 months of successful continuous full-time real-life experience in the desired gender; and  Complete 12 months of continuous cross-sex hormone therapy appropriate for the desired gender (unless medically contraindicated). HPN SHL makes no representation or warranty as to the medical competence or ability of any Gender Dysphoria Treatment Center/Facility or its respective staff or Physicians. HPN SHL shall have no liability or responsibility, either direct, indirect, vicarious or otherwise, or any actions or inactions, whether negligent or otherwise, on the part of any Gender Dysphoria Treatment Center/Facility or its respective staff or Physicians. Genetic Disease Testing Services Covered Services include Prior Authorized Medically Necessary Genetic Disease Testing, Testing when:  such Such testing is prescribed following the MemberInsured’s history, physical examination and pedigree analysis, genetic counseling, and completion of conventional diagnostic studies, and a definitive diagnosis remains uncertain and a genetic disease diagnosis is suspected, and;  the Member The Insured displays clinical features, or is at direct risk of inheriting the mutation in question (pre-symptomaticpresymptomatic); and  the The result of the test will directly impact the treatment being delivered to the MemberInsured. Healthcare Facility Services Covered Services include the following accommodations, services and supplies received during an admission to a Hospital, Ambulatory Surgical Facility, Skilled Nursing Facility, Residential Treatment Center or Hospice Care Facility. Accommodations:  Semiprivate (or multibed unit) room, including bed, board, board and general nursing care.  Private room including bed, board, and general nursing care, but only when treatment of the MemberInsured's condition requires a private room. The semiprivate room rate will be allowed toward the private room rate when a Member an Insured receives private room accommodations for any reason other than Medical Necessity.  Inpatient accommodations provided in connection with the birth of a child shall be provided for a minimum of forty-eight (48) hours following an uncomplicated vaginal delivery or a minimum of ninety-six (96) hours following an uncomplicated delivery by cesarean section. This provision does not require a Member an Insured to deliver in a Hospital or other healthcare facility or to remain therein for the minimum number of hours following delivery.  Intensive care unit (including Cardiac Care Unit), including bed, board, general and special nursing care, and ICU equipment. Agreement of Coverage  Observation unit, including bed, board, and general nursing care not to exceed twenty-three (23) hourshours per day.  Nursery charges for newborns. Services and Supplies. Covered Services and supplies provided by a Hospital, Ambulatory Surgical Facility, Skilled Nursing Facility, Residential Treatment Center or Hospice Care Facility include:  non-surgical Provider visits;  operating, recovery, and treatment rooms and equipment (Hospital and Ambulatory Surgical Facility only);  delivery and labor rooms and equipment (Hospital and Ambulatory Surgical Facility only);  anesthesia materials and anesthesia administration by Hospital staff (Hospital and Ambulatory Surgical Facility only);  clinical pathology and laboratory services and supplies;  services and supplies for diagnostic tests required to diagnose Insured's Illness, Injury or other conditions but only when charges for the services and/or supplies are made by the facility (Hospital, Skilled Nursing Facility and Ambulatory Surgical Facility only);  drugs consumed at the time and place dispensed which have been approved for general marketing in the United States by the Food and Drug Administration (FDA);  dressings, splints, casts and other supplies for medical treatment provided by the Hospital from a central sterile supply department;  oxygen and its administration;  non-replaced blood, blood plasma, blood derivatives, and their administration and processing;  intravenous injections and solutions;  private duty nursing subject to the benefit limitation for such services;  supportive services for a Hospice patient's family, including care for the patient which provides a respite from the stresses and responsibilities that result from the daily care of the patient and bereavement services provided to the family after the death of the patient (Hospice Care Facility only); and  Sterilization procedures.