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Board to consider April action after broad discussion on standardizing gender-dysphoria benefits
Summary
Director Dodd recommended aligning plan coverage with WPATH and DSM-5 standards, urging plans to adopt Blue Shields approach (review for medical necessity), eliminate a $75,000 cap in a UHC MAPD plan, and provide parity for travel/lodging; the item will return as an action in April after staff collect medical-necessity criteria and cost/claims data.
Director Catherine Dodd presented an extensive slide deck and recommended updates to the Health Service Systems gender-dysphoria benefits so that coverage across the systems vendors is consistent with World Professional Association for Transgender Health (WPATH) guidance and DSM-5 definitions. Dodd said Blue Shields approachreviewing certain reconstructive procedures for medical necessitywas the recommended model for all plans and flagged…
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