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San Francisco HSS adopts standardized gender‑dysphoria benefits, removes $75,000 lifetime cap in one plan
Summary
The San Francisco Health Service System board voted unanimously to adopt a policy harmonizing gender‑dysphoria benefits across its plans for 2018, removing a $75,000 lifetime cap in one Medicare Advantage plan and directing plans to review previously excluded services under medical‑necessity criteria.
The San Francisco Health Service System board voted unanimously March 9 to adopt a standardized Gender Dysphoria Policy Statement for 2018 and to eliminate a $75,000 lifetime cap that applied to gender‑dysphoria benefits in the fully insured UnitedHealthcare Medicare Advantage plan.
Acting Director Mitchell Griggs told the board HSS used its all‑payers claims database to estimate utilization and cost and provided counts of members seeking gender‑dysphoria‑related care: 26 claimants in 2014, 46 in 2015 and 55 in 2016. Griggs said staff recommended three measures: adopt the San Francisco policy statement, remove the lifetime cap…
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