State Employee Health Plans (Archived)

Plan Website: Alabama State Employees' Health Plan

Administrator: Blue Cross Blue Shield of Alabama

This plan is self-funded.

This plan has no exclusion.

Coverage:

No exclusion in plan, but limitations in the insurance administrator’s clinical criteria may cause denials that can be challenged.

Last updated on Jun 7, 2020.

Plan Website: Alaska State Employees' Health Plan

Administrator: Aetna

This plan is self-funded.

This plan has no exclusion.

Coverage:

The plan contains an exclusion, but the state is currently prohibited from enforcing it.

"Any treatment, drug or supply related to changing sex or sexual characteristics, with the exception of hormones and hormone therapy (p. 100); Any treatment, drug, service or supply related to changing sex or sexual characteristics, including:

• Surgical procedures to alter the appearance or function of the body.
• Prosthetic devices." (p. 108)

Litigation:

Fletcher v. State of Alaska successfully challenged the transgender exclusion. The court ruled the exclusion was unlawful and enjoined the state from enforcing it, but an appeal may be pending.

Last updated on Jul 2, 2020.

Plan Website: Arizona State Employee Health Plan

Administrator: Aetna, Blue Cross Blue Shield of Arizona, Cigna, UnitedHealthcare

This plan is self-funded.

This plan has an exclusion.

Exclusion:

Gender reassignment surgery. (p. 57)

Litigation:

Toomey v. State of Arizona is an on-going class-action lawsuit challenging the transgender exclusion.

Last updated on Jul 2, 2020.

Plan Website: Arkansas ARBenefits

Administrator: HMO Partners, Inc. d/b/a Health Advantage

This plan is self-funded.

This plan has an exclusion.

Exclusion:

Sex changes/sex therapy. Care, services, or treatment for non-congenital transsexualism, gender dysphoria, or sexual reassignment or change are not covered. This exclusion includes medications, implants, hormone therapy, surgery, medical, or psychiatric treatment or other treatment of sexual dysfunction including Prescription Medications and sex therapy. (p. 90)

Last updated on Jul 2, 2020.

Plan Website: California State Employees' Health Plan

Administrator: See notes

This plan has no exclusion.

Coverage:

Explicit coverage

Notes:

Plans are provided and/or administered by the following entities:

• Anthem Blue Cross (HMO)
• Anthem Blue Cross (EPO)
• Anthem Blue Cross Medicare (PPO)
• Blue Shield of California (HMO)
• Blue Shield of California (EPO)
• California Association of Highway Patrolmen (PPO)
• California Correctional Peace Officers Association (HMO)
• Health Net of California (HMO)
• Kaiser Permanente (HMO)
• Peace Officers Research Association of California (PPO)
• PERSCare (PPO)
• PERS Choice (PPO)
• PERS Select (PPO)
• Sharp Health Plan (HMO)
• UnitedHealthcare (Basic) (HMO)
• UnitedHealthcare (Medicare) (PPO)
• Western Health Advantage (HMO)

Last updated on Jan 31, 2020.

Plan Website: Colorado State Employees' Health Plan

Administrator: Cigna

This plan is self-funded.

This plan has no exclusion.

Coverage:

No exclusion in plan, but subject to coverage limitations in Cigna's clinical policy.

Plan Website: Colorado State Employees' Health Plan

Administrator: Kaiser

This plan is insured.

This plan has no exclusion.

Coverage:

No exclusion in plan, but Kaiser clinical criteria may contain exclusions

Last updated on Jun 2, 2021.

Plan Website: Connecticut State Employees' Health Plan

Administrator: UnitedHealthcare

This plan is self-funded.

Exclusion:

Must be 18 years of age or older [surgery] (p. 20); The following surgeries are considered cosmetic when used to improve the gender specific appearance of an individual who has undergone or is planning to undergo gender reassignment surgery and are not covered:

• Liposuction/body contouring
• Rhinoplasty
• Facial bone reconstruction
• Voice modification surgery
• Hair removal
• Face lift
• Blepharoplasty
• Reversal of genital surgery
• Sperm preservation in advance of hormone treatment or surgery
• Cryopreservation in advance of hormone treatment or surgery
• Surgical treatment of anyone under the age of 18. (p. 51)

Plan Website: Connecticut State Employees' Health Plan

Administrator: Anthem

This plan is self-funded.

Exclusion:

Must be 18 years of age or older [surgery] (p. 20); The following surgeries are considered cosmetic when used to improve the gender specific appearance of an individual who has undergone or is planning to undergo gender reassignment surgery and are not covered:

• Liposuction/body contouring
• Rhinoplasty
• Facial bone reconstruction
• Voice modification surgery
• Hair removal
• Face lift
• Blepharoplasty
• Reversal of genital surgery
• Sperm preservation in advance of hormone treatment or surgery
• Cryopreservation in advance of hormone treatment or surgery
• Surgical treatment of anyone under the age of 18. (p. 51)

Last updated on Jun 7, 2020.

Plan Website: Delaware First State Basic Plan

Administrator: Highmark

This plan is self-funded.

Exclusion:

Summary Plan Description has explicit coverage, but exclusions for people under 18, for facial surgeries, and hair removal (p. 30-32).

Plan Website: Delaware Aetna HMO

Administrator: Aetna

This plan is self-funded.

This plan has no exclusion.

Coverage:

Summary Plan Description has explicit coverage (pg. 28), but the plan does not cover expenses in excess of one surgical procedure per covered person per lifetime. (pg. 29)

Last updated on Mar 6, 2023.

Plan Website: Florida State Employees' HMO Health Plan

Administrator: Aetna

This plan has an exclusion.

Exclusion:

Gender reassignment or modification services and supplies (p. 59)

Notes:

Claire v. Florida Department of Management Services is an on-going case challenging the transgender exclusion.

Plan Website: Florida State Employees’ HMO Plan

Administrator: AvMed

This plan has an exclusion.

Exclusion:

Gender reassignment or modification services and supplies (p. 58)

Notes:

Claire v. Florida Department of Management Services is an on-going case challenging the transgender exclusion.

Plan Website: Florida State Employees’ PPO Plan

Administrator: Blue Cross Blue Shield of Florida

This plan has an exclusion.

Exclusion:

Sexual Reassignment, or Modification Services or Supplies, including, but not limited to, any health care service related to such treatment, such as services necessary to treat sexual deviations and disorders, psychosexual dysfunction or services or supplies provided in connection with intersex surgery. (p. 5-4)

Notes:

Claire v. Florida Department of Management Services is an on-going case challenging the transgender exclusion.

Plan Website: Florida State Employees’ HMO Plan

Administrator: Capital Health Plan

This plan has an exclusion.

Exclusion:

Gender reassignment or modification services and supplies (p. 58)

Notes:

Claire v. Florida Department of Management Services is an on-going case challenging the transgender exclusion.

Plan Website: Florida State Employees’ HMO Plan

Administrator: UnitedHealthcare

This plan has an exclusion.

Exclusion:

Gender reassignment or modification services and supplies (p. 61)

Notes:

Claire v. Florida Department of Management Services is an on-going case challenging the transgender exclusion.

Last updated on Jul 2, 2020.

Plan Website: Georgia State Health Benefit Plan

Administrator: Blue Cross Blue Shield of Georgia

This plan is self-funded.

This plan has an exclusion.

Exclusion:

Sex Change Services and supplies for a sex change and/or the reversal of a sex change. (p. 49)

Plan Website: Georgia State Health Benefit Plan

Administrator: UnitedHealthcare

This plan is self-funded.

This plan has an exclusion.

Exclusion:

Sex transformation operations and related services (p. 51)

Plan Website: Georgia State Health Benefit Plan

Administrator: Kaiser

This plan is insured.

Exclusion:

No exclusion

Last updated on Jul 2, 2020.

Plan Website: Hawaii State Employees' Health Plan

Administrator: Hawaii Medical Service Association

This plan is self-funded.

This plan has no exclusion.

Coverage:

There is no exclusion. Coverage is in accordance with HMSA's clinical policy, which contains certain exclusions.

Plan Website: Hawaii State Employees' Health Plan

Administrator: Kaiser

This plan is insured.

This plan has no exclusion.

Coverage:

No exclusion

Last updated on Jun 8, 2020.

Plan Website: Idaho State Employees' Health Plan

Administrator: Blue Cross of Idaho

This plan has an exclusion.

Exclusion:

For any treatment of either gender leading to or in connection with transsexual Surgery, gender transformation, sexual dysfunction, or sexual inadequacy, including erectile dysfunction and/or impotence, even if related to a medical condition, except as specified as a Covered Service in this Policy. (p. 43)

Last updated on Jan 31, 2020.

Plan Website: Illinois State Employees' Health Plan

Administrator: Aetna

This plan has no exclusion.

Coverage:

Fertility: You or your partner has not had infertility that resulted from gender reassignment surgery (female to male or male to female) (HMO p.28)

Plan Website: Illinois State Employees' Health Plan

Administrator: Blue Cross Blue Shield of Illinois

This plan has no exclusion.

Plan Website: Illinois State Employees' Health Plan

Administrator: ​Health Alliance Medical Plans

This plan has no exclusion.

Coverage:

No exclusion

Plan Website: Illinois State Employees' Health Plan

Administrator: Health Link

This plan has no exclusion.

Coverage:

Explicit coverage

Last updated on Jan 31, 2020.

Plan Website: Indiana State Employees' Health Plan

Administrator: Anthem

This plan is self-funded.

This plan has no exclusion.

Coverage:

Explicit coverage Gender Reassignment Surgery

Last updated on Jan 31, 2020.

Plan Website: Iowa State Employees' Health Plan

Administrator: Wellmark Blue Cross Blue Shield of Iowa

This plan is self-funded.

This plan has no exclusion.

Coverage:

No exclusion

Litigation:

Vroegh v. Iowa Department of Corrections (filed Iowa 2017). The ACLU filed a complaint with the Iowa Civil Rights Commission, which found probable cause that the DOC had discriminated against him for having a transgender exclusion in the self-funded employee health plan. The subsequent lawsuit brought Iowa Civil Rights Act and state equal protection claims. A jury awarded Vroegh $120,000 in damages

Last updated on Jun 9, 2020.

Plan Website: Kansas State Employee Health Plan

Administrator: Blue Cross and Blue Shield of Kansas

This plan is self-funded.

This plan has no exclusion.

Notes:

There was an exclusion from past years that has been removed.

Plan Website: Kansas State Employee Health Plan

Administrator: Aetna

This plan is self-funded.

This plan has no exclusion.

Coverage:

No exclusion

Notes:

There was an exclusion from past years that has been removed.

Last updated on Jul 2, 2020.

Plan Website: Kentucky State Employees' Health Plan

Administrator: Anthem Blue Cross Blue Shield

This plan is self-funded.

This plan has no exclusion.

Coverage:

Explicit coverage (p. 27)

Last updated on Jun 9, 2020.

Plan Website: Louisiana State Employees' Health Plan

Administrator: Blue Cross Blue Shield of Louisiana

This plan is self-funded.

This plan has an exclusion.

Exclusion:

Services, surgery, supplies, treatment or expenses for the following REGARDLESS OF CLAIM OF MEDICAL NECESSITY: treatment related to sex transformations (p. 84)

Litigation:

The State of Louisiana was a plaintiff in the case that challenged the implementation of the nondiscrimination regulations of Section 1557 of the Affordable Care Act, Franciscan Alliance v. Azar.

Last updated on Jul 2, 2020.

Plan Website: Maine State Employees' Health Plan

Administrator: Anthem Blue Cross Blue Shield

This plan is self-funded.

This plan has no exclusion.

Coverage:

No exclusion

Last updated on Jan 31, 2020.

Plan Website: Maryland State Employees' Health Plan

Administrator: Care First Blue Cross Blue Shield

This plan has no exclusion.

Coverage:

Explicit Coverage (p. 67)

Plan Website: Maryland State Employees' Health Plan

Administrator: Kaiser

This plan has no exclusion.

Coverage:

Explicit Coverage (p. 82 / p. 1 addendum)

Plan Website: Maryland State Employees' Health Plan

Administrator: United Healthcare

This plan has no exclusion.

Coverage:

Explicit Coverage (p. 47 / p. 39)

Last updated on Jan 31, 2020.

Plan Website: Massachusetts State Employees' Health Plan

Administrator: National Network - UniCare State Indemnity Plan/Basic with CIC (Comprehensive) - - Commonwealth of Mass Group Insurance Commission

This plan has no exclusion.

Coverage:

Explicit Coverage (p. 32)

Plan Website: Massachusetts State Employees' Health Plan

Administrator: Broad Network - Fallon Health - Commonwealth of Mass Group Insurance Commission

Notes:

Full plan available by request.

Plan Website: Massachusetts State Employees' Health Plan

Administrator: Broad Network - Harvard Pilgrim Commonwealth of Mass Group Insurance Commission

Plan Website: Massachusetts State Employees' Health Plan

Administrator: Broad Network - Tufts Healthplan Navigator Commonwealth of Mass Group Insurance Commission

Plan Website: Massachusetts State Employees' Health Plan

Administrator: Broad Network - Unicare State Indemnity- - Commonwealth of Mass Group Insurance Commission

Plan Website: Massachusetts State Employees' Health Plan

Administrator: Regional Network - Allway Health Partners HMO

Plan Website: Massachusetts State Employees' Health Plan

Administrator: Regional Network - Health New England HMO

Plan Website: Massachusetts State Employees' Health Plan

Administrator: Limited Network - Administrators are the same as "Broad Network"

Last updated on Jun 9, 2020.

Plan Website: Michigan State Employees' Health Plan

Administrator: Blue Cross Blue Shield of Michigan

Plan Website: Michigan State Employees' Health Plan

Administrator: Magellan Health - PPO Blue Care - HMO HAP - HMO

Plan Website: Michigan State Employees' Health Plan

Administrator: McLaren Health Plan - HMO

Plan Website: Michigan State Employees' Health Plan

Administrator: Physicians Health Plan - HMO

Plan Website: Michigan State Employees' Health Plan

Administrator: Priority Health - HMO

Plan Website: Michigan State Employees' Health Plan

Administrator: United Healthcare - HMO

Last updated on Jan 31, 2020.

Plan Website: Minnesota State Employees' Health Plan

Administrator: Minnesota Advantage Health Plan

This plan has no exclusion.

Coverage:

Treatment for gender dysphoria and gender reassignment if medically necessary based on the most recent, published standards of nationally recognized medical experts in the transgender field. Please consult your plan’s coverage criteria for more information. (p.45)

Last updated on Jan 31, 2020.

Plan Website: Mississippi State and School Employees’ Health Insurance Plan

Administrator: Blue Cross Blue Shield of Mississippi

This plan is self-funded.

This plan has an exclusion.

Exclusion:

Sex transformations

Litigation:

The State of Mississippi was a plaintiff in the case that challenged the implementation of the nondiscrimination regulations of Section 1557 of the Affordable Care Act, Franciscan Alliance v. Azar.

Last updated on Jul 2, 2020.

Plan Website: Missouri State Employees' Health Plan

Administrator: Missouri Consolidated Health Care Plan

This plan is self-funded.

This plan has no exclusion.

Notes:

As a state agency, all MCHCP “plan documents” are contained in state regulation. The state regulations can be viewed on the Missouri Secretary of State’s website. The changes for plan year 2020 can be found in the Missouri Register. The plan formerly contained an exclusion, but it was removed.

Last updated on Jul 2, 2020.

Plan Website: Montana State Employees' Health Plan

Administrator: Health Care and Benefits Division (within the MT Administration)

This plan is self-funded.

This plan has no exclusion.

Coverage:

Explicit coverage (p. 19)

Last updated on Jan 31, 2020.

Plan Website: Nebraska State Employees' Health Plan

Administrator: United HealthCare Services, Inc.

This plan is self-funded.

This plan has an exclusion.

Exclusion:

Sex transformation operations and related services

Litigation:

• A former state employee challenged the exclusion in Krei v. Nebraska, No. 4:19-cv-03068 (Mar. 16, 2020). Judge Brian C. Buescher dismissed her claims, but the reasoning in the opinion would not bar future state employees from successfully bringing a challenge.
• The State of Nebraska was a plaintiff in the case that challenged the implementation of the nondiscrimination regulations of Section 1557 of the Affordable Care Act, Franciscan Alliance v. Azar.
• The State of Nebraska also lead the effort to file an Amicus Brief in Support of Petitioner in R.G. Harris Funeral Homes, Inc. v Equal Opportunity Commission, in the U.S. Supreme Court.

Notes:

Nebraska offers several plans to state employees (Regular, Consumer Focused, and WellNebraska), but all are administered by United HealthCare Services and contain the same exclusion.

If you are a Nebraska state employee who has been affected by this exclusion, please contact us for more information about your rights.

Last updated on Jul 2, 2020.

Plan Website: Nevada PEBP Consumer Driven Health Plan (PPO)

Administrator: Public Employee Benefits Program

This plan is self-funded.

Exclusion:

Gender Dysphoria and/or Gender Reassignment Services: Certain procedures associated with gender dysphoria treatment and/or gender reassignment surgery are considered non-medically necessary, such as:

• No more than one gender reassignment surgery in the individual’s lifetime while covered under the PEBP CDHP Plan or any previous self-funded PPO Plan.
• Certain procedures are considered cosmetic, such as (this is not an all-inclusive list):
  • Blepharoplasty o Hair transplants, wigs, and hair growth products o Breast augmentation/augmentation mammoplasty, except when the gender reassignment patient has received 12 continuous months of hormonal (estrogen) therapy and the breast tissue growth failed to result a Tanner Stage 5 on the puberty scale, as determined by the provider, or the recipient has a medical contraindication to hormone therapy. The Plan Administrator will determine authorization and consent to care based on medical necessity.
  • Rhinoplasty Electrolysis (hair removal) Laser hair removal Facial reconstruction including facial feminization surgery to include but not be limited to facial bone reduction, face lift and certain facial plastic reconstruction. (The UM company to determine if a procedure is cosmetic and the Plan Administrator has discretionary authority to determine coverage.
• Other Exclusions include (this is not an all-inclusive list):
  • Sperm preservation in advance of hormone treatment or gender surgery
  • Cryopreservation of fertilized embryos
  • Voice modification surgery
  • Voice therapy
  • Drugs for sexual performance or cosmetic purposes (except for hormone therapy as described in this document)
  • Transportation, meals, lodging or other similar expenses associated with gender dysphoria services
  • One (1) gender dysphoria reassignment surgery per lifetime while covered under any current or previous PEBP self-funded health plan.

The UM company has full authority to determine if a procedure or service is not medically necessary. (p. 92-93 CDHP Plan).

This plan is self-funded.

Exclusion:

"This Plan excludes expenses related to cosmetic procedures performed as a component of a gender reassignment, including, but not limited to the following services:

• Abdominoplasty
• Blepharoplasty
• Breast augmentation*
• Brow lift
• Calf implants
• Cheek/malar implants
• Chin/nose implants
• Collagen injections
• Construction of a clitoral hood
• Drugs for hair loss or growth
• Face-lifting
• Facial bone reduction
• Forehead lift
• Hair removal
• Hair transplantation
• Lip enhancement or reduction
• Mastopexy
• Neck tightening
• Pectoral implants
• Reduction thyroid chondroplasty
• Removal of redundant skin
• Rhinoplasty
• Skin resurfacing
• Voice modification surgery (laryngoplasty or shortening of the vocal cords)
• Voice therapy/voice lessons

*Breast augmentation/augmentation mammoplasty excluded, except when the gender reassignment patient has received 12 continuous months of hormonal (estrogen) therapy and the breast tissue growth failed to result a Tanner Stage 5 on the puberty scale, as determined by the provider, or the recipient has a medical contraindication to hormone therapy. The Plan Administrator will determine authorization and consent to care based on medical necessity." (p. 88 Premier Plan)

Plan Website: Nevada Health Plan of Nevada (HMO)

Administrator: UnitedHealthcare

This plan is insured.

Exclusion:

"Services received in connection with Gender Dysphoria, which includes the following:

• Abdominoplasty;
• Blepharoplasty;
• Body contouring, such as lipoplasty;
• Breast enlargement, including augmentation mammoplasty and breast implants;
• Brow lift;
• Calf implants;
• Cheek, chin, and nose implants;
• Cryopreservation of fertilized embryos;
• Drugs for hair loss or growth;
• Face lift, forehead lift, or neck tightening;
• Facial bone remodeling for facial feminizations;
• Hair removal;
• Hair transplantation;
• Injection of fillers or neurotoxins;
• Lip augmentation;
• Lip reduction;
• Liposuction;
• Mastopexy;
• Pectoral implants for chest masculinization;
• Reversal of genital surgery or reversal of surgery to revise secondary sex characteristics;
• Rhinoplasty;
• Skin resurfacing;
• Sperm preservation in advance of hormone treatment or gender surgery;
• Surgical or hormone treatment on Members under eighteen (18) years of age;
• Surgical treatment not Prior Authorized by HPN;
• Thyroid cartilage reduction; reduction thyroid chondroplasty; trachea shave (removal or reduction of the Adam’s Apple);
• Transportation, meals, lodging or other similar expenses;
• Voice lessons and voice therapy; and
• Voice modification surgery." (p. 30 Health Plan of Nevada)

Last updated on Jul 2, 2020.

Plan Website: New Hampshire State Employees' Health Plan

Administrator: Anthem

This plan has no exclusion.

Coverage:

Explicit coverage (p. 63)

Last updated on Jan 31, 2020.

Plan Website: New Jersey State Employees' Health Plan

Administrator: Aetna

This plan has no exclusion.

Coverage:

Explicit Coverage (p. 222)

Plan Website: New Jersey State Employees' Health Plan

Administrator: Horizon Blue Cross Blue Shield of New Jersey

This plan has no exclusion.

Coverage:

Explicit Coverage (p. 222)

Last updated on Jan 31, 2020.

Plan Website: New Mexico State Employees' Health Plan

Administrator: Blue Cross Blue Shield of New Mexico, Presbyterian, and Cigna

Last updated on Mar 6, 2023.

Plan Website: New York State Employees' Health Program

Administrator: Empire Blue Cross Blue Shield

This plan has no exclusion.

Coverage:

No exclusion

Plan Website: New York State Employees' Health Program

Administrator: United Healthcare

This plan has no exclusion.

Coverage:

No exclusion

Last updated on Feb 1, 2020.

Plan Website: North Carolina State Employees' Health Plan

Administrator: Blue Cross Blue Shield of North Carolina

This plan is self-funded.

This plan has an exclusion.

Exclusion:

Psychological assessment and psychotherapy treatment in conjunction with proposed gender transformation (p. 42); Treatment or studies leading to or in connection with sex changes or modifications and related care (p. 52)

Litigation:

In Kadel v. Folwell, TLDEF and Lambda Legal are suing the North Carolina State Health Plan over its exclusion of transgender-related health care. We have received a favorable ruling allowing the plaintiffs to have their day in court.

Last updated on Jul 2, 2020.

Plan Website: North Dakota State Employees' Health Plan

Administrator: Sanford Health Plan

This plan is insured.

This plan has an exclusion.

Exclusion:

Coverage for hormones only: Non-Surgical, medically necessary treatment, of Gender Dysphoria (Gender Identity Disorder), including hormone therapy, mental/behavioral services, and laboratory testing to monitor the safety of continuous hormone therapy, per Plan guidelines (available upon request). (p. 42)

Last updated on Mar 6, 2023.

Plan Website: Ohio State Employees' Health Plan

Administrator: Aetna

This plan is self-funded.

This plan has an exclusion.

Exclusion:

Sex change: Any treatment, drug, service or supply related to changing sex or sexual characteristics, including:

• Surgical procedures to alter the appearance or function of the body;
• Hormones and hormone therapy;
• Prosthetic devices; and
• Medical or psychological counseling (p. 46)

Plan Website: Ohio State Employees' Health Plan

Administrator: Anthem

This plan is self-funded.

This plan has an exclusion.

Exclusion:

Sexual Transformation - Surgical care or medical treatment or study related to the modification of sex (transsexualism) and related services, or the reversal thereof. (p. 42)

Plan Website: Ohio State Employees' Health Plan

Administrator: Medical Mutual of Ohio

This plan is self-funded.

This plan has an exclusion.

Exclusion:

Transsexual Surgery or any treatment leading to or in connection with transsexual Surgery. (p. 40)

Last updated on Jan 31, 2020.

Plan Website: Oklahoma BlueLincs HMO

Administrator: Blue Cross Blue Shield of Oklahoma

This plan is insured.

Exclusion:

No exclusion.

Notes:

The Blue Cross Blue Shield of Oklahoma medical policy will apply.

Plan Website: Oklahoma CommunityCare HMO

Administrator: CommunityCare HMO

This plan is insured.

This plan has an exclusion.

Exclusion:

Transsexual Surgery:

Sex reassignment surgery, including related pre- or post-surgery procedures, services, psychiatric evaluation, treatment, medications and supplies, including services to treat complications arising from transsexual surgery. (p. 81)

Plan Website: Oklahoma GlobalHealth HMO

Administrator: GlobalHealth

Exclusion:

No exclusion.

Notes:

GlobalHealth does not have a specific medical policy on gender dysphoria.

Plan Website: Oklahoma HealthChoice High, High Alternative, Basic, Basic Alternative and High Deductible Health Plan

Administrator: Office of Management and Enterprise Services Employees Group Insurance Division

This plan is self-funded.

This plan has an exclusion.

Exclusion:

Sex transformation surgeries (p. 38, 2022 handbook)

Last updated on Mar 6, 2023.

Plan Website: Oregon State Employees' Health Plan

Administrator: Public Employees Benefit Board / Moda Health

This plan has no exclusion.

Coverage:

7.5.13 Gender Identity Disorder/Gender Dysphoria Services

To be eligible for coverage, all services must be Medically Necessary.

Coverage includes:

• Mental health
• Hormone therapy (including puberty suppression therapy for adolescents)
• Surgical procedures

The Plan covers expenses for gender reassignment under the following conditions:

• The procedure(s) must be performed by a qualified professional provider
• The professional provider must obtain prior authorization for the surgical procedure
• The treatment plan must meet medical necessity criteria
• Covered procedures include:
  • Breast/chest surgery for female-to-male (FtM)
  • Gonadectomy (hysterectomy/oophorectomy for FtM or orchiectomy for MtF)
  • Single stage or multiple stage reconstruction of the genitalia
• The following procedures are excluded, unless the medical necessity criteria are met:
  • Blepharoplasty
  • Hair removal for surgical reconstruction (i.e. genital hair removal)
  • Breast augmentation procedures
  • Voice therapy/voice modification
  • Removal of redundant skin (i.e. Panniculectomy)

The following services are not medically necessary for all medical conditions and are excluded from coverage by the Plan as part of gender identity disorder treatment:

• Rhinoplasty
• Face-lifting
• Lip enhancement
• Facial bone reduction
• Brow Lift
• Liposuction/abdominoplasty of the waist (body contouring)
• Reduction of thyroid chondroplasty
• Facial hair removal/hair transplantationVoice modification surgery (laryngoplasty or shortening of the vocal cords)
• Skin resurfacing used in feminization
• Chin implants/Cheek Implants
• Nose implants
• Lip reduction
• Collagen injections
• Reversal, revision, or removal of gender reassignment surgery
• Make up evaluation
• Legal expenses related to name change
• Travel and lodging expenses

(p. 37 -38)

Plan Website: Oregon State Employees' Health Plan

Administrator: Kaiser

This plan has no exclusion.

Coverage:

When a Participating Provider determines that a recommended Service is medically appropriate for an individual and the individual satisfies the criteria for the Service or treatment, we will provide coverage for the recommended Service regardless of sex assigned at birth, gender identity, or gender of the individual otherwise recorded by us. p. 17 Gender Affirming Treatment defined on p. 3 - Medical treatment or surgical procedures, including hormone replacement therapy, necessary to change the physical attributes of one’s outward appearance to accord with the person’s actual gender identity.

Plan Website: Oregon State Employees' Health Plan

Administrator: Providence

This plan has no exclusion.

Coverage:

5.10.16 Gender Dysphoria

Benefits are provided for the treatment of Gender Dysphoria. Covered Services include, but are not limited to, Mental Health, Prescription Drug, and surgical procedures. Coverage is provided at the applicable benefit level for the type of Covered Services received, as shown in your Benefit Summary. For example, surgical procedures are subject to your provider surgical benefit and applicable inpatient or outpatient facility benefit. Treatment of Gender Dysphoria is subject to Medical Necessity as set forth in our medical policy, and must be received from licensed providers and facilities. Prior Authorization may apply. Please see section 4.4 for a list of services requiring Prior Authorization. (p. 43-44)

Last updated on Jan 31, 2020.

Plan Website: Pennsylvania State Employees' Health Plan

Administrator: Highmark

This plan is self-funded.

This plan has no exclusion.

Coverage:

Explicit coverage (p. 35), but subject to claims payors clinical criteria

Plan Website: Pennsylvania State Employees' Health Plan

Administrator: Aetna

This plan is self-funded.

This plan has no exclusion.

Coverage:

Explicit coverage (p. 35), but subject to claims payors clinical criteria

Plan Website: Pennsylvania State Employees' Health Plan

Administrator: Geisinger

This plan is self-funded.

This plan has no exclusion.

Coverage:

Explicit coverage (p. 35), but subject to claims payors clinical criteria

Last updated on Jan 31, 2020.

Plan Website: Rhode Island State Employees' Health Plan

Administrator: Blue Cross Blue Shield of Rhode Island

This plan is self-funded.

This plan has no exclusion.

Coverage:

"This Plan covers services related to gender reassignment. Preauthorization may be required for gender reassignment surgical services."

However, claims will be evaluated according to BCBS of Rhode Island's clinical policy, which excludes certain procedures.

Last updated on Jun 2, 2021.

Plan Website: South Carolina State Employees' Health Plan

Administrator: Blue Cross Blue Shield of South Carolina

This plan is self-funded.

This plan has no exclusion.

Last updated on Mar 6, 2023.

Plan Website: South Dakota State Employees' Health Plan

Administrator: South Dakota State Emloyee Benefits Program

This plan is self-funded.

This plan has an exclusion.

Exclusion:

Services or drugs related to gender transformations. (p. 55)

Litigation:

Bruce v. State of South Dakota, No. 5:17-cv-05080-JLV (D.S.D. filed Oct. 13, 2017). In this ACLU case, Mr. Bruce brought Title VII and Equal Protection claims challenging a blanket exclusion in the South Dakota state employee health plan. The case was voluntarily dismissed following Mr. Bruce’s death.

Last updated on Mar 6, 2023.

Plan Website: Tennessee State Employees' Health Plan

Administrator: Cigna

This plan is self-funded.

This plan has an exclusion.

Plan Website: Tennessee State Employees' Health Plan

Administrator: Blue Cross Blue Shield of Tennessee

This plan is self-funded.

This plan has an exclusion.

Exclusion:

Surgery or treatment for, or related to, psychogenic sexual dysfunction or transformation other than psychological treatment or counseling. (p. 21)

Last updated on Mar 6, 2023.

Plan Website: Texas HealthSelect of Texas

Administrator: Blue Cross Blue Shield of Texas

This plan is self-funded.

This plan has an exclusion.

Exclusion:

gender reassignment surgery and related services (p. 101 In-Area Benefits Plan; p. 94 Out-of-State Benefits Plan)

Plan Website: Texas Consumer Directed HealthSelect

Administrator: Blue Cross Blue Shield of Texas

This plan has an exclusion.

Exclusion:

gender reassignment surgery and related services (p. 80 Consumer Directed HealthSelect)

Plan Website: Texas Community First Health Plans

Administrator: Community First Health Plans

This plan is insured.

This plan has an exclusion.

Exclusion:

Sex Changes. All services, medications and/or supplies furnished in conjunction with the sex change process. This includes hormonal medications required before and after surgery. (p. 43 Certificate of Group Health Care Coverage)

Plan Website: Texas Scott and White Health Plan HMO

Administrator: Scott and White

Exclusion:

Infertility benefits do not include sterilization reversal, transsexual surgery, gender reassignment, intra-fallopian transfer and related services, artificial insemination, or in-vitro fertilization. Also excluded from coverage are any services or supplies used in any procedures performed in preparation for or immediately after any of the above referenced excluded procedures. (p. S5 Evidence of Coverage)

Last updated on Mar 6, 2023.

Plan Website: Utah State Employees' Health Plan

Administrator: Public Employees Health Program

This plan is self-funded.

This plan has an exclusion.

Exclusion:

The Master Policy for PEHP contains an exclusion, "Gender reassignment Surgery, unless otherwise allowed by Employer Group." (p. 33) The 2020-21 Benefits Summary for the State of Utah does not indicate that there is coverage.

Last updated on Jul 2, 2020.

Plan Website: Vermont State Employees' Health Plan

Administrator: Blue Cross Blue Shield of Vermont

This plan is self-funded.

This plan has no exclusion.

Last updated on Jun 9, 2020.

Plan Website: Virginia State Employees' Health Plan

Administrator: Anthem

This plan is self-funded.

This plan has no exclusion.

Coverage:

No exclusion

Notes:

Removed exclusion in 2016 in response to Section 1557 ("Gender Reassignment – remove exclusion for services for gender reassignment (sex transformation). This includes Medical, Behavioral Health and Outpatient Prescription Drug services (Page 102)")

Plan Website: Virginia State Employees' Health Plan

Administrator: Kaiser

This plan is insured.

This plan has no exclusion.

Coverage:

No exclusion

Last updated on Jun 9, 2020.

Plan Website: Washington Uniform Medical Plan

Administrator: Regence BlueShield

This plan is self-funded.

This plan has no exclusion.

Coverage:

"The following services associated with a diagnosis of gender dysphoria are covered at the standard rate for outpatient services and at the inpatient rate for inpatient services.

• Non-surgical services, including but not limited to hormone therapy, office visits, mental health/counseling, and tests.
• Covered surgical services.

This is not a complete list of medical and surgical treatments of gender dysphoria in transgender individuals. For more information on transgender services, please visit regence.com/ump/pebb/benefits/policies to find a link to the clinical criteria for transgender services. Some services and prescription drugs associated with gender dysphoria may require preauthorization." (p. 69)

Plan Website: Washington Kaiser Foundation Health Plan of the Northwest

Administrator: Kaiser Foundation Health Plan of the Northwest

This plan is insured.

This plan has no exclusion.

Coverage:

"We cover surgery Services subject to Utilization Review by Kaiser using criteria developed by Medical Group and approved by Kaiser. You may request these criteria by calling Member Services. You pay any applicable Deductible, Copayment, or Coinsurance that you would pay if the Services were not related to transgender surgery. Coverage includes Services directly related to the covered transgender surgery, such as pre-surgery consultations and post-surgery follow-up exams; outpatient surgery procedures; and inpatient hospital Services (including room and board). There are other related Services that are not covered under this section, but they may be covered under other sections in this COC. Examples of these Services are: psychological counseling is covered under the “Mental Health Services” section, outpatient prescription drugs under the “Prescription Drugs, Insulin and Diabetes Supplies” and outpatient laboratory and imaging Services are covered under the “Diagnostic Testing” section" (p. 59)

Plan Website: Washington Kaiser Foundation Health Plan of Washington

Administrator: Kaiser Foundation Health Plan of Washington

This plan is insured.

This plan has no exclusion.

Coverage:

"Medical and surgical services for gender reassignment. Prescription drugs are covered the same as for any other condition (see Drugs – Outpatient Prescription for coverage). Counseling services are covered the same as for any other condition (see Mental Health for coverage). Non-Emergency inpatient hospital services require Preauthorization." (p. 37)

Last updated on Mar 6, 2023.

Plan Website: West Virginia State Employees' Health Plan

Administrator: UMR (UnitedHealthcare)

This plan is self-funded.

This plan has an exclusion.

Exclusion:

Surgical or pharmaceutical treatments associated with gender dysphoria or any physical, psychiatric, or psychological examinations, testing, treatments or services provided or performed in preparation for, or as a result of, sex transformation surgery (pp. 73, 81)

Litigation:

Litigation challenging the exclusion has been filed by Lambda Legal: Fain v. Crouch.

Last updated on Nov 13, 2020.

Plan Website: Wisconsin State Employees' Health Plan

Administrator: Wisconsin Public Employees Health Insurance Program

This plan is self-funded.

This plan has no exclusion.

Coverage:

Gender Reassignment

Based on a permanent injunction issued on October 11, 2018 and the summary judgment decision issued on September 18, 2018 by the federal district court for the Western District of Wisconsin, all procedures, services, and supplies related to surgery and sex hormones associated with gender reassignment should be reviewed by the health plans for medical necessity. “Medically necessary” is defined in the Section I., Definitions of the Uniform Benefits section of the State of Wisconsin Group Health Insurance Program Agreement. (p. 35 - 36)

Litigation:

In Boyden v. State of Wisconsin the ACLU successfully challenged the exclusion of transgender-related care under the Wisconsin state employee health plan.

Boyden v. State of Wisconsin, No. 17-CV-264-WMC (D. Wisc. Jun. 7, 2019), ECF No. 261 (awarding $780,500 in damages to two plaintiffs, including for reimbursement of facial reassignment surgery).

Last updated on Mar 6, 2023.

Plan Website: Wyoming State Employees' Health Plan

Administrator: Cigna

This plan is self-funded.

This plan has no exclusion.

Coverage:

No exclusion

Last updated on Jan 31, 2020.