Caring for transgender individuals
Transgender individuals have health care needs and human needs, such as the need for respect, love and access to care. Aetna®. standard plans provide access to medically necessary transgender-related health care. Plan documents outline the member’s specific coverage.
The pharmacy benefit usually covers testosterone or estrogen therapies. Clinical Policy Bulletins #510 Progestins and #501 Gonadotropin-Releasing Hormone Analogs outline the coverage of relevant medications.
Our Clinical Policy Bulletin #615 Gender-Affirming Surgery outlines what surgeries are covered by standard Aetna plans. Also, find out more about gender affirmation surgery precertification (PDF).
To find a breast surgeon in the network, gender reassignment surgery designated surgeons (PDF)
Behavioral health services
Individuals considering a surgical transition will need:
- One letter from a mental health care ;provider for breast (top) surgery
- Two letters from a mental health care provider for genital (bottom) surgery
Some Aetna® plans may cover fertility preservation. These services need precertification. Check the ;benefits plan documents for coverage details.
Ongoing health and wellness
- Benefits for preventive health services (such as cancer screening) are based on the individual’s birth anatomy (cervix, breast, prostate).
- Discuss safe sex practices and screenings for sexually transmitted infections.
Discuss the risks of alcohol and tobacco while undergoing hormone therapy and preparing for surgery.