EHP Expands Gender-Affirming Care Benefits

As an organization committed to the health and well-being of our LGBTQ+ members and families, Johns Hopkins Employer Health Program (EHP) has greatly expanded its gender-affirming care benefits and supports. Effective July 1, 2022, your EHP health plan was updated with important benefit expansions of a range of gender-affirming care. Gender-affirming care is evidence-based medical best practice that, for transgender, non-binary and gender-diverse people, is essential health care that enhances quality of life and overall well-being.

The previous EHP benefits for gender-affirming care were limited to a range of gender-affirming surgeries in addition to hormone therapy. The updated benefits extend coverage to include additional gender-affirming care procedures, including voice therapy and facial reconstructive procedures.

EHP members are authorized to receive expanded services for adjunctive gender-affirming treatment and procedures when ALL of the following criteria are met:

  • The member is 18 years of age or older
  • Persistent, well-documented gender dysphoria
  • Capacity to make fully informed decisions and consent for treatment
  • The member has reached the legal age of medical consent
  • If significant medical or mental health issues are present, they must be well controlled

The expanded coverage for reconstructive and adjunctive treatment/surgery includes the following:

  • Abdominoplasty
  • Blepharoplasty
  • Botox injections
  • Brow lift
  • Calf Implants
  • Cheek/malar implants
  • Chin contouring (genioplasty)/implants
  • Collagen injections
  • Cranial prosthesis (wig)
  • Face lift
  • Forehead reduction and contouring
  • Facial bone reduction (osteoplasty)
  • Flaps, grafts and/or tissue transfer directly related to a covered procedure
  • Frontal sinus remodeling
  • Gluteal augmentation (implants/lipofilling)
  • Hair removal/hair transplantation
  • Jaw reduction (masseter reduction), contouring, augmentation
  • Laryngoplasty/voice modification surgery (concurrent speech therapy recommended)
  • Lip lift and lip filling
  • Male chest reconstruction/pectoral implants
  • Mastopexy
  • Orbital reconstruction
  • Panniculectomy
  • Repair of introitus
  • Rhinoplasty
  • Skin resurfacing (dermabrasion/chemical peels)
  • Suction assisted lipoplasty, lipofiling, liposuction, fat grafting for body contouring (e.g., waist contouring)
  • Thyroid chondroplasty/chondrolaryngoplasty/tracheal shave
  • Voice modification speech therapy

The following breast/chest and genital surgical procedures are also now covered for EHP members:

  • Breast prosthesis/implant
  • Coloproctostomy
  • Flaps, grafts and/or tissue transfer directly related to a genital reconstructive procedure
  • Mastopexy
  • Tattooing for nipple and phallus reconstruction

The following updates were also made to EHP’s gender affirmation coverage:

  • When a systemic complication such as sepsis, infection, hemorrhage or other serious documented medical complication occurs as a result of any surgical procedure, treatment of the complication is considered medically necessary.
  • Revision surgery may be considered medically necessary to approximate functional anatomy.
  • Medically reasonable adjunctive procedures performed to enhance the ability of a member to live aligned with their gender identity will be considered for coverage as defined in the treating provider’s treatment plan, established in conjunction with the member to relieve gender incongruence.
  • Note: Particular consideration will be given to whether the proposed procedure(s) advances an individual’s ability to properly present and function in the identified gender role, including non-binary role.

Gender affirmation services for EHP members require prior authorization. Providers can submit prior authorization requests to the Utilization Management department using the following dedicated fax numbers:

Fax: 800-261-2421 or 410-424-4480

Covered services will be paid according to the current plan benefit for the type of service provided. Consult your EHP pharmacy formulary for specific puberty suppression and gender-affirming hormone coverage.

Learn more about accessing gender-affirming care on the website for the Johns Hopkins Center for Transgender Health.

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