Insurance Coverage for Transgender Care

Trans Insurance Roadmap video series

The era of routine exclusion of transgender-related care is over. No one should be paying for hormones, surgeries, or puberty-delaying treatment out of pocket anymore.

Our Trans Insurance Roadmap videos are the place to start learning about your health care rights. The videos cover the basics of learning what your plan will cover, how to apply for coverage, and what your options are if you are denied.

does my plan cover trans care

How do I know what my plan covers?

If you watched Video 1, you know you need two documents to start to determine what is covered under your plan:

  1. Your insurance plan document (your health insurance policy)
  2. Generic insurance company medical policy on gender reassignment

Learn more about what the plan document it is and how to get it: How do I get a copy of my health insurance policy?

Find your insurance company's policy on gender reassignment here: Transgender Insurance Medical Policies

Challenging insurance denials and exclusions

If you have determined that you have a self-funded plan, you may wish to speak with HR about any denials you have received. If there is a blanket exclusion in your plan, you can ask them to remove it. If you are concerned about retaliation, speak with an attorney before proceeding. You can direct HR to our legal memorandum on transgender insurance exclusions, which makes the business and legal case for removing exclusions.

If you have received a denial based an asserted lack of medical necessity (as opposed to a generic exclusion for all gender reassignment procedures), you will need to go through the internal and external appeals processes. You can print out and include the relevant medical necessity evidence. We have compiled such evidence in literature reviews that you can find on our resources page.

Many states have issued insurance bulletins prohibiting bans on transgender health care, so if you live in one of those states and have an insurance plan, you can file a complaint with the insurance division of your state. Many state Attorney General offices also accept complaints against health insurance companies. Such complaints are not a substitute for going through the appeals process, which you still must do.

Note: Transcend Legal is not taking new clients at this time.