To receive credit in the CEI, a company must:

• Answer “yes”
• Upload a copy of the summary plan description (or summary material modification) that explicitly affirms coverage for transition-related care.
• Upload a copy of the applicable clinical guidelines (also called a medical policy).

To receive credit in the CEI, a company must:

• Upload a copy of a summary plan description (or summary material modification) that explicitly affirms coverage of transition-related care.

More information:

• A summary plan description is a document that tells the plan participant (employee) that their specific plan provides and how it operates. For self-insured plan sponsors (employers), this document is unique to the organization.
• Covered benefits must include
  • Mental health counseling
  • Hormone replacement therapy
  • Routine doctor’s visits and lab testing
  • Surgical procedures
  • Paid short-term leave (whether employer
    provided or employer purchased)

Examples:

• Dana-Farber Cancer Institute's plan through Harvard Pilgrim Healthcare outlines the covered health services for transgender employees, along with other important information about obtaining coverage.
• UNC Health's plan details the different treatments for gender dysphoria that are covered by their plan.

Note: In order to receive credit, your company MUST submit a plan-specific document (such as a summary plan description, summary material modification, benefits summary, schedule of benefits, etc.) that affirms coverage of transition-related care. A clinical policy alone cannot be accepted for credit.

To receive credit in the CEI, a company must:

• Upload a copy of the applicable medical policy for transition-related services, treatment of gender dysphoria, or similar title.

• A clinical policy bulletin (or medical policy) is a document that explains an insurer's determination of whether a service is medically necessary, how coverage is administered by the insurer and under what circumstances. Clinical policy bulletins are not benefit contracts and do not constitute coverage on their own.
• Learn more about these documents here

Examples:

• Transgender and Gender Diverse Services - BCBS Massachusetts
• Gender Reassignment Surgery with Related Services - BCBS Illinois

Note: For the purposes of the CEI, a clinical policy alone (without a summary plan description or the like) is insufficient for credit. The reason for this is: clinical policies (aka medical policies) are an explanation of how a benefit is medically administered and managed and they do not constitute proof of coverage. This is clearly stated in most clinical policies documents.

To receive credit in the CEI, a company must:

• Have at least one plan that covers the following benefits for the treatment of gender dysphoria:
  • Mental health counseling
  • Hormone replacement therapy
  • Routine doctor’s visits and lab testing
  • Surgical procedures
  • Paid short-term leave (whether employer provided or employer purchased)

More Information:

• Baseline surgical procedure coverage must include reconstructive chest/breast and genital surgeries for transmasculine and transfeminine individuals.

To receive credit in the CEI, a company must:

• Have eliminated all separate monetary caps of transition-related coverage. Plans with monetary caps (regardless of amount) cannot be accepted for credit.

More information:

• Treatment is Not Expensive: Includes available cost and utilization data demonstrating that costs of treatments are inexpensive and utilization of benefits is low.

To receive credit in the CEI, a company must:

• Have eliminated all blanket exclusions for transition-related care across all health care plans
• Have the appropriate executive-level person confirm that all benefit plans have been reviewed and blanket exclusions on transition-related care have been removed by affirming the following statement with a digital signature:
  • I can affirm that all benefit plans have been examined, and no blanket exclusions on transition-related care are included in any of the company's benefit plans.

More information:

• A complete list of exclusions will be found in the insurance contract, and partial lists are usually found in summary plan documents.