Medical Needs Planning

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    Medical Needs Planning

    medical planning with a doctor

    Health plans must cover certain preventive services, at no cost to you, when delivered by an in-network doctor or provider. Therefore, your health insurance company cannot deny sex-specific recommended preventive services based on your sex assigned at birth, gender identity, or recorded gender.

    Many health plans are still using exclusions such as “services related to sex change” or “sex reassignment surgery” to deny coverage to transgender people for certain health care services.

    If your doctor determines that the preventive service is medically appropriate for you and you meet the criteria for this recommendation and coverage requirements, your plan must cover the service without charging you a co-payment or co-insurance, even if you haven’t met your yearly deductible.

    Before you enroll in any health plan, review and understand the terms of coverage. Plans might use different language to describe exclusions. Look for language like “All procedures related to being transgender are not covered.” Other terms to look for include “gender change,” “transsexualism,” “gender identity disorder,” and “gender identity dysphoria.”

    You can access the full terms of coverage through a plan’s Summary of Benefits and Coverage. If you are still unsure about which services would be covered or excluded, contact the plan’s issuer directly by phone.

    TransLucent Resources will assist you with understanding your medical plan coverage and provides referral services to medical providers that specialize in transgender care.