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Supporting you on your health care journey
Most Blue Cross and Blue Shield of North Carolina (Blue Cross NC) plans provide coverage1 for individuals whose gender identity differs from sex assigned at birth.
Our customer service team can connect you with a nurse case manager for gender services who has specialized knowledge to help you:
- Understand your benefits
- Navigate gender affirmation surgery and hormone therapy
- Learn more about gender-affirming care
You can learn more about your coverage by reviewing your Benefit Booklet in your Blue Connect℠ member portal or by contacting us.
Gender-affirming care in our plans
Gender-affirming care may cover a range of services and health care needs. The following services may be covered as part of an overall treatment plan for gender dysphoria2:
- Hormone therapy or pubertal delay
- Gender-affirming surgeries, including genital and chest procedures
- Voice therapy
- Some electrolysis or laser hair removal procedures2
- Mental health support
Some services may require prior authorization from your health care plan. If you have any questions, get in touch with us, and one of our customer service representatives can help.
Hormone therapy
Hormone therapy may be covered when it is part of your benefit plan3and when it is medically necessary for the treatment of gender dysphoria.
Gender affirmation surgery
Gender affirmation surgery may be covered when it is part of your benefit plan3and when it is medically necessary for the treatment of gender dysphoria. This may include:
- Vaginoplasty
- Phalloplasty
- Hysterectomy
- Mastectomy
- Breast reconstruction, including augmentation with implants
- Certain facial procedures for feminization or masculinization2
How coverage works
For individual members under 65
All standard Blue Cross NC individual and family plans4 cover gender-affirming care as outlined in our coverage policy. Services may require prior approval.
Learn more about the services covered3 in our individual and family medical policy and in your Benefit Booklet.
For Medicare members 65 and up
Coverage for Medicare Advantage members is based on guidance from the Centers for Medicare & Medicaid Services (CMS).
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.
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.
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.
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Disclosures:
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This is not a guarantee of coverage. Please consult your Blue Cross NC coverage documents for information specific to your situation.
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Limitations and restrictions may apply based on factors specific to your medical needs and the terms of your plan, including, but not limited to your age, medical needs, treatment history, and medical necessity policies. Coverage may also vary as required by state law.
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Not applicable for non-commercial plans.
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Standard plan designs are default plans designed by Blue Cross NC that have not been customized by employer groups. Plan designs may also change depending on whether your plan is fully insured or self-funded by your employer.
Blue Cross NC offers several decision-support tools to aid you in making decisions around your health care experience. These tools are offered for your convenience and should be used only as reference tools. You should consult your own legal counsel, tax advisor or personal physician as applicable throughout your health care experience.
Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.
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