Harvard Pilgrim Health Care

Policy Number
Transgender Health Services
Policy Issued In
Massachusetts
Last Update
Breast Reconstruction

Harvard Pilgrim Health Care (HPHC) considers transgender surgical services as medically necessary when documentation and letters from the attending clinician(s) and mental health professional (MHP) responsible for managing the member’s hormone therapies (if appropriate) and/or other related transgender care confirm ALL the following:

  1. Member age 18 years or older has been diagnosed (by an appropriately trained MHP) with gender dysphoria/gender incongruence; AND
  2. Member wishes to make his/her body as congruent as possible with the gender identity through surgery and/or hormone replacement (if appropriate); AND
  3. Transgender surgery has been recommended by treating clinicians

Transfeminine surgeries covered include:

  • Augmentation mammoplasty

 

Permanent Hair Removal
  • Electrolysis or laser hair removal pre-operatively for genital reconstructive procedures (i.e. Clitoroplasty, Colovaginoplasty, Labiaplasty, Orchiectomy, Penectomy, Vaginoplasty), for a maximum of six treatment sessions
  • Electrolysis or laser hair removal pre-operatively for genital reconstructive procedures (i.e. Colpectomy, Metoidioplasty, Phalloplasty, Scrotoplasty), for a maximum of six treatment sessions
Facial Reconstruction

Harvard Pilgrim Health Care (HPHC) considers transgender surgical services as medically necessary when documentation and letters from the attending clinician(s) and mental health professional (MHP) responsible for managing the member’s hormone therapies (if appropriate) and/or other related transgender care confirm ALL the following:

  1. Member age 18 years or older has been diagnosed (by an appropriately trained MHP) with gender dysphoria/gender incongruence; AND
  2. Member wishes to make his/her body as congruent as possible with the gender identity through surgery and/or hormone replacement (if appropriate); AND
  3. Transgender surgery has been recommended by treating clinicians

Transfeminine surgeries covered include:

  • Facial feminization procedures
    • Tracheoplasty
    • Blepharoplasty (lower and upper eyelid)
    • Blepharoptosis
    • Brow Ptosis
    • Rhytidectomy
    • Suction assisted lipectomy
    • Genioplasty
    • Osteoplasty
    • Otoplasty
    • Rhinoplasty
    • Forehead contouring
    • Mandible/jaw contouring
Fertility Preservation

Harvard Pilgrim Health Care (HPHC) also covers retrieval, cryopreservation, and storage (up to one year) of sperm or eggs when documentation confirms an eligible member with gender dysphoria/gender incongruence will be undergoing gender reassignment treatment that is likely to result in infertility.

Youth Services

Consideration for breast and chest surgery (e.g. nipple areola reconstruction, mastectomy, breast augmentation) will be given to trans-adolescents under the age of 18 who meet all other policy criteria (e.g. hormone therapy).