Transgender and Gender-Affirming Benefits Guide

This guide outlines the transgender and gender-affirming benefits and services provided by Aetna. It details the coverage for medically necessary services based on the Standards of Care published by the World Professional Association for Transgender Health (WPATH). The document explains eligibility criteria for gender-affirming surgical procedures, including requirements for breast and genital surgeries, such as age, diagnosis of gender dysphoria, and necessary referrals. It also lists covered services, including various surgical procedures, hormone therapy, and mental health services. Additionally, the guide provides information on costs, including the need for precertification for certain services and the implications of using in-network versus out-of-network providers. There are also sections on travel and lodging benefits for members who need to travel for services not available within a certain distance. Overall, the document serves as a comprehensive resource for understanding and utilizing Aetna's transgender and gender-affirming benefits.