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Clinical policy bulletins State Deviations

Deviations to Aetna Clinical Policy Bulletins based on state regulations

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For members of plans governed by the State of California, medically necessary speech therapy services are covered whether or not a member's speech impediment and/or developmental disability has a physical cause.

 

CPB 0243: Speech Therapy
 

For members of HMO/HNO plans regulated by the State of California Department of Managed Health Care, all cosmetic procedures that are performed as a component of a gender transition must be reviewed for medical necessity.

 

CPB 0615: Gender Affirming Surgery
 

Pursuant to New York Department of Financial Services Insurance Circular Letter #3 issued 2/23/21, members covered under New York student health plans and fully-insured plans who are unable to conceive due to their sexual orientation or gender identity, and who also have coverage subject to the infertility mandates located at NY Insurance Law §§ 3221(k)(6)and 4303(s), are entitled to immediate coverage of certain infertility diagnostic and treatment services, including intrauterine insemination procedures, so long as the member’s plan otherwise covers the benefit being requested.

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Health benefits and health insurance plans contain exclusions and limitations.

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