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Health Insurance Medical Policies - Fertility Preservation


Below are excerpts from various health insurance medical policies that have explicit provisions detailing when fertility preservation is covered for transgender people.

The fact that an insurance company is listed here does not mean that your particular plan will follow these guidelines. You must look to your individual policy to determine if transgender care is covered or excluded. Only if it is covered will the policies below apply.

Policy: Gender Reassignment Surgery

Related Policy: Infertility Services Medical Policy

Cryopreservation of Eggs/Embryos
NHP covers cryopreservation and storage for up to one year’s storage when authorized in accordance with this policy
and when one of the following criteria is met: ...
3. Female member will be undergoing medical treatment (e.g. chemotherapy, radiation, and gender reassignment)
excluding voluntary sterilization that is likely to result in permanent infertility, and NHP has authorized an IVF
cycle for stimulation and retrieval. Cryopreservation of eggs/embryos will be covered for up to one year from
the time of the egg retrieval.

Cryopreservation of Sperm
NHP covers cryopreservation and storage for up to one year’s storage for a male member who meets one of the
following criteria: ...
3. Male member will be undergoing medical or surgical treatment (e.g. chemotherapy, radiation, gender
reassignment surgery) excluding voluntary sterilization that is likely to result in permanent infertility. In this case
the male member and/or couple do not need to be already receiving NHP‐authorized in infertility services. There
must be a >5% probability of a future live birth using the member’s cryopreserved sperm.

In Vitro Fertilization (IVF) for Member not in Active Infertility Treatment
NHP covers one cycle of IVF for the purpose of egg retrieval, processing and fertilization and a single cryopreservation of eggs/embryos for up to one year, when there is documentation that a member will be undergoing medical or surgical
treatment (e.g. chemotherapy, radiation, gender reassignment), that is likely to result in permanent infertility.

 

 

Policy: Gender Assignment Surgery and Gender Reassignment Surgery with Related Services

Procurement, cryopreservation/freezing, storage/banking, and thawing of reproductive tissues, such as oocytes, ovaries, embryos, spermatozoa, and testicular tissue may be considered medically necessary for individuals with gender dysphoria because gender reassignment services, such as long-term cross-sex hormone therapy or surgical procedures, may render an individual infertile whether or not the individual has reproduced in the past.

See related policy:

OB402.023 Reproductive Technologies or Techniques and Related Services

Policy: Gender Affirming Services (Transgender Services)

Oocyte, embryo, or sperm retrieval, freezing and storage for up to 24 months for transgender members prior to undergoing hormone therapy or genital sex reassignment surgery may be considered MEDICALLY NECESSARY. (See medical policy #086, Infertility Diagnosis and Treatment)

• Per subscriber certificate language, cryopreservation is limited to one cycle only.

Policy: Gender Assignment Surgery and Gender Reassignment Surgery with Related Services

Procurement, cryopreservation/freezing, storage/banking, and thawing of reproductive tissues, such as oocytes, ovaries, embryos, spermatozoa, and testicular tissue may be considered medically necessary for individuals with gender dysphoria because gender reassignment services, such as long-term cross-sex hormone therapy or surgical procedures, may render an individual infertile whether or not the individual has reproduced in the past.

See related policy:

OB402.023 Reproductive Technologies or Techniques and Related Services

Policy: Gender Assignment Surgery and Gender Reassignment Surgery with Related Services

Procurement, cryopreservation/freezing, storage/banking, and thawing of reproductive tissues, such as oocytes, ovaries, embryos, spermatozoa, and testicular tissue may be considered medically necessary for individuals with gender dysphoria because gender reassignment services, such as long-term cross-sex hormone therapy or surgical procedures, may render an individual infertile whether or not the individual has reproduced in the past.

See related policy:

OB402.023 Reproductive Technologies or Techniques and Related Services

Policy: Gender Assignment Surgery and Gender Reassignment Surgery with Related Services

Procurement, cryopreservation/freezing, storage/banking, and thawing of reproductive tissues, such as oocytes, ovaries, embryos, spermatozoa, and testicular tissue may be considered medically necessary for individuals with gender dysphoria because gender reassignment services, such as long-term cross-sex hormone therapy or surgical procedures, may render an individual infertile whether or not the individual has reproduced in the past.

See related policy:

OB402.023 Reproductive Technologies or Techniques and Related Services

Policy: Gender Assignment Surgery and Gender Reassignment Surgery with Related Services

Procurement, cryopreservation/freezing, storage/banking, and thawing of reproductive tissues, such as oocytes, ovaries, embryos, spermatozoa, and testicular tissue may be considered medically necessary for individuals with gender dysphoria because gender reassignment services, such as long-term cross-sex hormone therapy or surgical procedures, may render an individual infertile whether or not the individual has reproduced in the past.

See related policy:

OB402.023 Reproductive Technologies or Techniques and Related Services

 

Policy: Gender Affirmation Surgeries

Feminizing/masculinizing hormonal therapy and/or gender affirmation surgeries may limit the member’s fertility. Plan medical criteria for infertility services (covered for some Plan products) are listed in the Plan’s Infertility Services medical policy, policy number OCA 3.725; this medical policy and the member’s applicable benefit documents are available at for BMC HealthNet Plan members.

Policy: Transgender Health Services

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.

Policy: Transgender Health Services

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.

Policy: Gender Identity Services

Fertility counseling is covered (subject to Limitations and Administrative Guidelines) when all of the following criteria are met:

  1. Fertility counseling is provided by a qualified health care professional; 
  2. The service is provided prior to removal of testes or ovaries; and
  3. The counselor documents that the patient has been advised about contraceptive use, effects of transition on fertility, and options for fertility preservation and reproduction
Policy: Gender Dysphoria Treatment Excluding California

Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service. The documentation requirements outline below are used to assess whether the member meets the clinical criteria for coverage but do not guarantee coverage of the service requested.

Policy: Gender Dysphoria (Gender Identity Disorder) Treatment

Coverage is available for medical, behavioral or pharmacological treatment that is Medically Necessary for Gender Dysphoria. UnitedHealthcare does not exclude or deny covered health care benefits based on associated diagnosis of Gender Dysphoria, or otherwise discriminate against the member on the basis that treatment is for Gender Dysphoria.

Policy: Gender Dysphoria (Gender Identity Disorder) Treatment

Coverage is available for medical, behavioral or pharmacological treatment that is Medically Necessary for Gender Dysphoria. UnitedHealthcare does not exclude or deny covered health care benefits based on associated diagnosis of Gender Dysphoria, or otherwise discriminate against the member on the basis that treatment is for Gender Dysphoria.

Policy: Gender Identity Services

Fertility counseling is covered (subject to Limitations and Administrative Guidelines) when all of the following criteria are met:

  1. Fertility counseling is provided by a qualified health care professional;
  2. The service is provided prior to removal of testes or ovaries; and
  3. The counselor documents that the patient has been advised about contraceptive use, effects of transition on fertility, and options for fertility preservation and reproduction.