U-M health plans to expand coverage for transgender members

April 22, 2019  //  FOUND IN: Our Employees

U-M health plan members who are transgender will soon have coverage for additional medical procedures.

All U-M health plans cover genital surgery, mastectomy in female-to-male transition, hormone therapy and counseling when medically necessary to treat gender dysphoria. As of July 1, the plans will also cover certain facial feminization surgeries, Adam’s apple reduction and facial hair removal.

Gender dysphoria involves a conflict between a person’s gender identity and their gender assigned at birth, causing significant distress.

In a recent review of coverage for gender-affirming services, U-M clinicians and policy experts considered medical evidence as well as benefits at peer institutions and corporate employers. The university accepted their recommendation to identify the additional services as medically necessary.

Coverage for these services will require that members meet medical-necessity criteria and use in-network providers, up to a $30,000 lifetime limit.

Transgender members may also utilize new coverage for fertility preservation if medical or surgical interventions related to their transition could result in infertility. This benefit is available to any U-M health plan member with infertility due to medical treatment or surgery.

U-M’s scope of coverage for gender-affirming services is among the most comprehensive in higher education. Coverage follows standards defined by the World Professional Association for Transgender Health. As WPATH issues new standards over time, the university may re-evaluate coverage and medical necessity criteria as needed.

Click here for the gender-affirming services fact sheet and click here for information regarding infertility and fertility preservation coverage.