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Gender dysphoria services, including gender reassignment surgery (GRS), may be covered when medically necessary and if the individual meets all criteria.
A clinical review of benefits must be submitted to evaluate medical necessity or medical appropriateness of the proposed treatment. If there is a discrepancy between the Medical Policy and a member's benefit plan, summary plan description or contract, the benefit plan, summary plan description or contract will govern.
Medical policy for gender assignment surgery and gender reassignment surgery with related services