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.
- Example from Aetna
- Learn more about these documents here
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.
Transgender people continue to face significant hurdles in accessing their health benefits. Additionally, we routinely find employers assume or believe they have coverage in place when, in fact, it is not part of their contract. For these reasons the CEI requires explicit language that affirms transition-related care in the plan or contract documentation such as the Summary Plan Description, Summary Material Modification, Contract Rider, open enrollment Summary of Benefits or some other contractual document. Employers with self-insured plans should be able to add this language as part of the benefits template.