High Option Plan

Gender Affirming Care

This plan recognizes that transgender, non-binary, and other gender diverse members require health care delivered by healthcare providers experienced in gender affirming health. This page will help members navigate our gender affirmation surgical benefits.

Gender affirming chest, genital, and facial feminization/masculinization surgeries are covered when medically necessary and meet the following criteria:

Note: Your provider must submit a treatment plan including all surgeries planned and the estimated date each will be performed. A new prior approval must be obtained if the treatment plan is approved and your provider later modifies the plan.

Note: We only cover procedures outlined in Table 1 of Cigna's Medical Coverage Policy for Gender Dysphoria Treatment.

Gender affirmation surgery on an inpatient or outpatient basis is subject to the pre-surgical requirements listed below. The patient must meet all requirements. 

• Prior approval is obtained (Call Cigna at 877-220-NALC (6252) for prior approval)

• Patient must be at least 18 years of age at the time prior approval is requested and the treatment plan is submitted

• Diagnosis of gender dysphoria by a qualified healthcare professional 
• Patient’s gender dysphoria is not a symptom of another mental disorder 
• Gender dysphoria causes clinical distress or impairment in social, occupational, or other important areas of functioning 
• 6 months of continuous hormone therapy appropriate to the patient’s gender identity
• If medical or mental health concerns are present, they are being optimally managed and are reasonably well-controlled 

• Reversal of a gender affirmation surgery is covered only when determined to be medically necessary or a complication occurs.