Gender care and coverage overview

Blue Cross is committed to equitable standards of care and health coverage for transgender and non-binary people

Committed to equitable care and access

All people should have equal opportunity to live consistently with their gender identity. That's why we're committed to supporting transgender and non-binary individuals, their families and their employers.

This is a partnership. We recognize that transgender and non-binary people are one of many marginalized groups who experience inequitable care and service within the health care system. We want to change that.

We are collaborating with our transgender associates and members and want to walk with them, and you, through the health care and insurance systems so we can hopefully make navigating them far easier for others in the future. If you have any questions about gender-related care, we encourage you to reach out to our Gender Services Team. We are here to listen, discuss, and provide whatever support you need.

Gender Services Team

Guidance for Blue Cross's transgender and non-binary members to help manage your care and navigate insurance 

Toll-free: (866) 694-9361  

gender.services@bluecrossmn.com

Here to help

  • Answer gender-related care questions
  • Connect you to health plan benefits
  • Understand your plan and coverage
  • Find the right doctor and care
  • Submit claims for hair removal 

See Gender Services FAQ

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Folx Health

LGBTQ+ specialized virtual care for Medicaid and employer-provided plan members

Comprehensive range of services*, including gender-affirming care, primary care, mental health care, sexual and reproductive health services, fertility consultations, and more. 

*In-network for MN residents

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Care and coverage

Check coverage for gender-affirming care

Coverage for any medical procedure, including gender-affirming procedures, varies by health plan. It’s important to understand what your specific health plan covers and what treatment choices, such as out-of-network providers or non-covered services, may lead to more personal expenses. The first place you should look is your benefit booklet.

Find your benefit booklet

  • Step 1: Log into your member account
  • Step 2: Select "Coverage" and download your benefit booklet
  • Step 3: Search for items like "Gender Confirmation Care and Services" and/or "Gender Dysphoria"

While being transgender or non-binary is not a mental disorder, gender dysphoria refers to the distress that may accompany the conflicting feelings between one’s experienced or expressed gender and one’s assigned gender. Most plans include some form of mental health support.

If you can't find the information you are looking for, call our Gender Services Team at 866-694-9361 toll-free or call the customer service number on the back of your member ID card.

In some instances, employer groups choose to not cover transition-related gender confirmation care and services. If that is true for your plan, you will be able to locate that information in the general exclusions section of your benefit booklet. If you can't find your benefit booklet, please call the customer service number on your member ID card for help.

Find the right care

Ultimately, you can see any doctor you'd like. But in-network providers are more affordable. If you choose to see providers who are not in your plan’s network, you will likely have to pay for more or all of that care.

You can find your network name by logging into the member portal and use our Find a Doctor tool to confirm which providers are considered "in-network" for you.

Our Gender Services Team is also available to help you find a doctor and connect you to providers who have experience with gender care.

Learn more about networks

Frequently asked questions

What does my insurance cover regarding gender affirming care?

We need your member ID and group number to check your benefit booklet to see if gender-affirming care is covered or if specific gender-affirming services are included. Please contact customer service (the number is on the back of your insurance card) or our gender care team for that information.

What if I don't have coverage, the insurance under my employer doesn't offer coverage, or the service I want is not covered?

What is included in the specific insurance product you have, and who the decision maker will be, varies depending on how you get your insurance. You can always reach out to the gender services team to learn more about your unique plan and what your care options are.

Are there individual plans available for purchase?

There may be an option to purchase an individual plan either as your primary insurance or a supplement to an employer policy. We recommend making sure you are eligible for services before purchasing. For contact information and more details about buying a plan, visit bluecrossmn.com/contact.

Do I need to be 18 years old to have insurance to cover my gender affirming surgeries?

For plans that use the Blue Cross Gender Affirming Policy, age limitations or requirements will be stated within the policy.

What hair removal provider can I go to? How do I get hair removal if hair removal businesses don't accept insurance?

If your plan provides coverage for gender affirming care, and if the provider is contracted with Blue Cross, they will submit claims on your behalf. However, if the provider is not contracted with us, you can get hair removal services from a provider of your choice but you will need to pay up-front for the service, then submit claims to get reimbursed. Please contact gender.services@bluecrossmn.com for assistance with submitting these claims.

Will a hair removal provider be considered in-network or out-of-network?

If your plan provides coverage for gender affirming care, they will be considered in-network.

Do I need a mental health provider letter for hormones/HRT?

This depends on your specific health plan and the medication being prescribed. Please call the number on the back of your insurance card and/or Customer Service to confirm benefits and coverage requirements.

How do I submit hair removal claims for reimbursement?

Please contact gender.services@bluecrossmn.com if you need assistance submitting a hair removal claim.

What is the process for getting a letter(s) of support?

Steps:

  1. Find a mental health provider if you do not already have one. If you need assistance, reach out to our Gender Services Team.
  2. Find a second mental health provider IF you are getting bottom surgery. The second provider should be a Mental Health Professional who you do not have an ongoing relationship with but who can provide an evaluation.
  3. Print out a copy or email the medical policy to your mental health provider and ask them to write a letter that addresses all the required criteria listed in the medical policy.
  4. Find a provider you feel comfortable with for your procedure. If you need assistance or have questions about provider options, reach out to our Gender Services Team.
  5. Send your letter(s) to your provider(s).
  6. Your provider(s) will send your letter(s) to Blue Cross Blue Shield of Minnesota with their clinical information when submitting the Prior Authorization request for your surgery.
     

Who can write the letter of support for me? Who/what type of provider qualifies per the medical policy?

Providers that meet the Minnesota Department of Human Services (MDH) qualifications for a mental health professional can write this letter. MDH has two categories for this.

Minnesota Statutes §245.4871 Subd. 26 is a Mental Health Practitioner that has at least a bachelor's degree in behavioral health or has worked with individuals with mental health concerns for at least 4,000 hours AND receives treatment supervision.

Minnesota Statutes §245.4871 Subd. 27 is a Mental Health Professional who is independently licensed. These can include psychiatrists, registered nurses that specialize in mental health, psychologists, social workers, counselors or marriage and family therapists. Common credentials (letters) associated with Mental Health Professionals in Minnesota are LICW, LMFT, LPCC, LP, MD, PMHNP and FNP.

Does my mental health provider need to have specific letters behind their name to write me a letter for medical necessity?

Please see above.

Who should I send the mental health provider's letter (letter of support) to, once obtained?

Keep a copy for your records. If this is for hair removal services only, please email the letter to gender.services@bluecrossmn.com. If this is for surgery, please email/provide the letter to your surgeon's office, who will send the letter(s) to Blue Cross with their Prior Authorization paperwork.

What kind of documentation is required to get covered for gender-affirming care or service(s)?

You need a letter from your mental health provider that is written addressing and validating the requirements that are listed in the medical policy- Opens in a new window needed to meet the criteria for the service.

If you are seeking bottom surgery, you will need two letters: one from your mental health provider and the second from a mental health professional who you do not have an ongoing relationship with but has only provided an evaluation.

How do I qualify for voice surgery? Do I need a letter from my treating speech therapist (in addition to my mental health provider)?

If your plan provides coverage for gender affirming care, medical necessity must be documented. You will need to do this via a letter from your treating speech therapist (who will indicate that speech therapy was tried and failed, and surgery will provide further benefit) and your mental health provider.

How does my surgeon, or other providers, get my letter from my mental health provider regarding medical necessity?

You will need to provide a copy of the letter by mail, email or in-person. Please ask your surgeon's office how they would like to obtain a copy of the letter.

Where can I change the name or gender listed in my insurance file?

This depends on your plan, so please contact our team at gender.services@bluecrossmn.com or (866) 694-9361 for a personalized answer.

I have BluePlus/Medicaid. Can you help me?

Yes, we have a dedicated team member who works with Medical Assistance (Medicaid) members. Please email gender.services@bluecrossmn.com or (866) 694-9361 and provide your name, the name listed on your health insurance card, member ID, date of birth and what you need assistance with.

Where can I find a trans-friendly provider?

We can help you find a trans or non-binary friendly provider. Email us at gender.services@bluecrossmn.com or call (866) 694-9361.

Do Medical Assistance (Medicaid) plans administered by Blue Cross use the DHS policy or the BCBSMN policy in a new window for gender affirming care?

If you have a Medicaid plan through Blue Cross, then the BCBSMN policy is what applies.

What if I need to travel out-of-state for a provider? Does my insurance pay travel expenses?

This depends on your plan so please contact our team at gender.services@bluecrossmn.com or (866) 694-9361 for a personalized answer.

Do I need to be on hormones for a specific amount of time to ‘qualify’ for surgery?

The response to this question depends on your plan, so please read the answer below that correlates with your plan.

  • Plans that use the BCBSMN Gender Affirming Medical Policy: Hormone therapy is not required for some surgeries and is recommended for a duration of 12 months for others (as appropriate to your gender goals). This includes Medicare Advantage Plans.
  • Medicare: Here is an article with some information on this question. However, we highly recommend contacting Medicare for an answer to this question.
  • Federal Employee Plans (FEP) - Member must meet the following criteria:
    • Living 12 months of continuous, full-time, real-life experience as desired gender (including place of employment, family, social and community activities)
    • 12 months of continuous hormone therapy appropriate to the member's gender identity (not required for mastectomy)

How our Gender Services Team can help

Transgender individuals, their families and their employers are welcome to reach out to our Gender Services Team. All conversations are confidential and complimentary.

We can help answer gender-related care questions.

While we cannot offer specific medical advice, we can help explain common gender-related care options like hormone treatment, puberty blockers, gender affirming behavioral health services, top and bottom surgery, hair removal and more. 

Ask whatever is on your mind and we'll do our best to answer your questions and provide more information. 

We can help connect you to health plan benefits.

All health insurance plans include many benefits, such as preventive care coverage, mental health support, chronic disease management and more. 

We can help you determine what your plan offers and direct you to additional resources that support your whole wellness. We can also help you understand your coverage for gender-affirming hair removal and how to submit claims.

We can help explain health insurance and your coverage.

We'll do our best to guide you and can help review your plan information to determine your coverage, potential costs and best in-network options. 

When appropriate, our Gender Services Team may pull in another Blue Cross customer service representative to help answer specific coverage and claim questions. 

We can help you navigate the health care system.

We can help you find doctors and clinicians who are experienced in serving gender non-conforming patients, review your general care options and generally troubleshoot any problems you might encounter. 

Consider us your one-stop-shop for navigating health care to make your gender care decisions.

Blue Cross and Blue Shield of Minnesota medical policies apply generally to all Blue Cross and Blue Plus plans and products. Benefit plans vary in coverage and some plans may not provide coverage for certain services addressed in the medical policies.

Medicaid products and some self-insured plans may have additional policies and prior authorization requirements. As applicable, review the provisions relating to a specific coverage determination, including exclusions and limitations. Note that services with specific coverage criteria may be reviewed retrospectively to determine if criteria are being met. Retrospective denial of claims may result if criteria are not met.

For Medicare NCD and/or Medicare LCD, please consult CMS or National Government Services websites.

Folx Health is an independent company that provides gender care services.