Table 2.

Examples of Transgender-Specific Exclusions and Flagging or Denial Based on Gender Marker in Online Insurance Plan Information

Location on website	Transition-related services and exclusions language and examples
Transgender-specific exclusions
Disclaimer	“Surgery, sex hormones, and related medical, psychological and psychiatric services to change a Member's sex; services and supplies arising from complications of sex transformation.”
Device policy	“Orthopedic and prosthetic devices, including penile prostheses, for the treatment of gender identity/gender dysphoria.”
Gender-marker-related restrictions
Formulary key	Symbol for gender-limited medications
Plan booklet	“Benefits are provided for female Members for Covered Services provided by any HMO participating obstetrical/gynecological Specialist without a Referral. Covered Services include: A. Routine maternity care; B. Routine gynecological care including Pap smears; and C. Other gynecological care.”
Pharmacy policy disclaimer	“Some medications may be subject to precertification, age, gender or quantity restrictions.”
FAQs	“What are age and gender limits? Age and gender limits are restrictions on coverage of drugs designed to prevent potential harm to plan participants and promote appropriate utilization. The approval criteria are based on information from the FDA, medical literature, actively practicing consultant physicians and pharmacists, and appropriate external organizations, and are endorsed by the Pharmacy and Therapeutics Committee.”
Restrictions on male and female medication	Androgel medications fell in the male-only category. Depo-provera fell in the female-only category.
Formulary search tool requiring gender and age for medication search	“I would like to search for a drug as a: M/F, Age”
Female-specific preventive care services	Breast and cervical cancer screening, chlamydia and gonorrhea screening, domestic/interpersonal violence screening, HPV DNA testing, osteoporosis screening, well-women visits, etc.