MMC Benefits Handbook
Gender Reassignment Surgery
NOTE: Out-of-network services are not covered under the Anthem BCBS Narrow Network (National Blue High Performance Network (Blue HPN)) except for urgent and emergency care. There are some providers in New Jersey and Philadelphia that are listed as Tier 2 on Anthem BCBS's provider search (National Blue High Performance Network (Blue HPN)) that can be used and are covered at the out-of-network benefit level. Providers not labeled as Tier 2 cannot be used for out of network coverage.
Does the Plan cover Gender Reassignment surgery?
Gender Reassignment surgery is covered for persons that meet all of the following conditions:
  • You are at least 18 years old
  • You have been diagnosed with Gender Dysphoria.
  • Preauthorization is required. Contact the Claims Administrator for specific details.
What Gender Reassignment surgery benefits will the Plan pay?
The Plan will provide medically necessary benefits in connection with Gender Reassignment surgery.
Call the Claims Administrator at the number on the back of your ID card for specifics on what is covered and excluded by the Plan.