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Members

Gender-affirming care

We’re committed to providing equitable and affordable health care for our transgender and nonbinary members. We’re here to support you on your health care journey, regardless of the destination.

Read Our Medical Policy(PDF)

Our coverage

Most Blue Cross and Blue Shield of North Carolina (Blue Cross NC) plans provide coverage1 for people whose gender identity differs from sex assigned at birth. Typically, the following services are covered as part of an overall treatment plan for gender dysphoria2 :

  • Genital procedures
  • Chest procedures (mastectomy, reconstruction, augmentation or reduction)
  • Facial procedures for feminization or masculinization
  • Voice therapy
  • Electrolysis or laser hair removal
  • Gender-affirming hormone therapy or pubertal delay
  • Mental health support

Services may require prior approval from your health care plan. If you have any questions, give us a call, and one of our customer service representatives can help.

Gender-affirming care in our plans

All standard Blue Cross NC plans3 cover gender-affirming care as outlined in our coverage policy, but some employer group plans may choose not to cover these services. Check your benefit booklet or call the number on the back of your member ID card for more details. You can find your benefit booklet by logging into Blue Connect.

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Hormone therapy

Hormone therapy is covered when it is part of your benefit plan and when it is medically necessary for the treatment of gender dysphoria.

Gender affirmation surgery

Gender affirmation surgery is covered when it is part of your benefit plan and when it is medically necessary for the treatment of gender dysphoria.

Most of the time, these surgeries are covered when you have completed 12 months of continuous hormone therapy.

Surgeries that may be covered if medically necessary as part of an overall treatment plan include:

  • Vaginoplasty
  • Phalloplasty
  • Hysterectomy
  • Mastectomy
  • Breast reconstruction, including augmentation with implants
  • Certain facial procedures

For a full list of covered surgical procedures, view our medical policy and your benefit booklet.

Find care that's right for you

Find in-network doctors, facilities, prescriptions, and more. Explore care options, or log in to Blue Connect to search existing coverage.

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Have questions for us?

If you have questions about which services are covered by your plan, call the number on the back of your member ID card.

You can also ask our customer service team to connect you with a nurse case manager for gender services. Our nurse case managers have specialized knowledge to help you understand your benefits, navigate gender affirmation surgery and hormone therapy, and learn more about transgender services.

Additional resources

Frequently asked questions

According to the World Professional Association for Transgender Health, gender dysphoria is the discomfort or distress that might occur in people whose gender identity differs from their sex assigned at birth or sex-related physical characteristics.

While all standard Blue Cross NC plans cover gender-affirming care, some employer groups may choose not to provide this coverage. Restrictions may also apply based on state law. Please check your benefit booklet for details.

If your plan does provide coverage for gender-affirming care, some limitations and exclusions may still apply.

For example, most of the time, coverage of gender affirmation surgery requires that you have lived for a minimum of 12 consecutive months as your affirmed gender and completed 12 consecutive months of hormone therapy under the supervision of a physician. (Mastectomies may not require hormone therapy). You must be 18 or older for these surgical procedures.

Similarly, most of the time, hormone therapy and pubertal delay require that you have lived for a minimum of 12 consecutive months as your affirmed gender, with no returning to your gender assigned at birth. If you have not met the 12-month timeframe criteria, your doctor must submit information about why it would be clinically inappropriate to require you to do so.

In general, gender affirmation surgery and hormone therapy are not covered when they are not considered medically necessary. Certain procedures, including collagen injections, lip filler, skin resurfacing and abdominoplasty, are considered not medically necessary as part of gender affirmation surgery.