Health plan benefits for transgender individuals
If you or a loved one are transgender, please read the update below about coverage for transgender-related care.
You may have heard about a new regulatory directive issued to California health plans by the California Department of Managed Health Care (DMHC) on April 9, 2013. The directive requires health plans with benefits that are regulated by the DMHC to provide transgender individuals with the same benefits that are available to non-transgender individuals.*
We want you to know that Kaiser Permanente’s health plans regulated by the DMHC now include coverage for medically necessary health care services for transgender individuals including, for example, behavioral health services, hormone therapy, and transgender surgery. General exclusions and limitations that apply to all services also apply to transgender services.
Some of our health plans were previously permitted to exclude coverage for transgender surgery. We are no longer applying that exclusion in our DMHC-regulated health plans. If you’re enrolled in one of those health plans, this means that you now have transgender surgery benefits even if your current Evidence of Coverage document lists transgender surgery as an exclusion. Also, for our DMHC-regulated health plans that previously covered transgender surgery and included a lifetime dollar limit on the surgery benefits, as of April 9, 2013, we are no longer applying those dollar limits.
For more information about these benefits, please contact our Member Service Contact Center at1-800-464-4000 (toll free). Learn more about transgender issues in our health encyclopedia.
Our Medi-Cal plans, KPIC insurance plans, and Kaiser Permanente employee benefit plans also include coverage for these services. Medicare and Federal Employees Health Benefits (FEHB) plans, and most employer self-funded plans administered by Kaiser Permanente, do not include coverage for transgender surgery. Beginning January 1, 2014, FEHB plans will provide coverage for transgender surgery.