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Transgender Benefits

VMware is proud to offer coverage for a diagnosis of Gender Dysphoria under our UnitedHealthcare (UHC) self- insured UHC HSA PPO and Traditional PPO plans.

Eligibility

VMware covered employees and qualified dependents covered on the UHC Medical plans with a confirmed diagnosis of Gender Dysphoria

Coverage Information

Members covered under the UHC Medical plans please refer section Gender Dysphoria coverage section for details under  Summary Plan Description listed under the Notices and Documents on the US Benefits webpage

Note: Using Out of Network coverage have certain limitations and coverage information.

Here are some covered procedures under the UnitedHealthcare (UHC) medical plans.  Please refer to the applicable coverage section under Summary Plan Description.

Transgender Benefits

Benefits for the treatment of Gender Dysphoria provided by or under the direction of a Physician.

For the purpose of this Benefit, Gender Dysphoria is a disorder characterized by the specific diagnostic criteria classified in the current edition of the Diagnostic and Statistical Manual of the American Psychiatric Association.

Prior Authorization for Surgical Treatment:

You must obtain prior authorization as soon as the possibility of surgery arises.

Prior Authorization Requirement for Non-Surgical Treatment

Depending upon where the Covered Health Care Service is provided, any applicable prior authorization requirements will be the same as those stated under each Covered Health Care Service category in the schedule of benefits listed under Gender Dysphoria.

Non-Surgical Treatments:

• Psychotherapy for Gender Dysphoria and associated co-morbid psychiatric diagnoses. Refer to Mental Health Care under the Summary Plan Description
• Cross-sex hormone therapy – hormones of the desired gender:
  • Cross-sex hormone therapy administered by a medical provider (for example during an office visit). Refer to coverage as described under Pharmaceutical Products – Outpatient in the Summary Plan Description.
  • Cross-sex hormone therapies that are dispensed from a pharmacy are not covered under the medical plan. Please refer to the CVS Caremark Summary Plan Attachment and the US Benefits website under Pharmacy
  • A Covered Person must meet eligibility qualifications for hormone therapy (in addition to the plan’s overall eligibility requirements). Generally, requirements include that a Covered Person must have persistent, well-documented gender dysphoria; have the capacity to make fully informed decisions and to consent for treatment; and, that any other presenting medical or mental health concerns must be reasonably well- controlled.
• Laboratory testing to monitor the safety of continuous cross-sex hormone
• Puberty suppressing medications injected or implanted by a medical provider in a clinical Eligibility qualifications include, but are not limited to:
  • Diagnosis of gender dysphoria by a mental health professional with expertise in child and adolescent psychiatry.
  • Medication is prescribed by a pediatric endocrinologist, or a physician in consultation with a pediatric
  • Patient has experienced puberty development to at least Tanner stage 2, and laboratory tests confirm pubertal levels of
  • Patient demonstrates knowledge and understanding of the expected outcomes of treatment and related transgender

Surgical Treatments:

• Surgery for the treatment for Gender Dysphoria, including but not limited to, the surgeries listed below, and must be appropriate to each covered person:

Genital Male to Female:

• Clitoroplasty (creation of clitoris)
• Coloproctostomy (formation of an artificial passage between the colon and rectum)
• Labiaplasty (creation of labia)
• Orchiectomy (removal of testicles)
• Penectomy (removal of penis)
• Plastic repair of introitus (uterine opening)
• Urethroplasty (reconstruction of female urethra)
• Vaginoplasty (creation of vagina)/Penile skin inversion

Non-Genital Male to Female:

• Augmentation mammoplasty (breast augmentation)
• Electrolysis or laser hair removal
• Nipple reconstruction
• Facial bone reduction/remodeling (facial feminization)
• Reduction Thyroid Chondrophasy (tracheal shaving)
• Rhinoplasty (Nose reshaping)
• Rhytidectomy (face lift)
• Voice Modification Surgery

Genital Female to Male:

• Bilateral mastectomy or breast reduction
• Hysterectomy (removal of uterus)
• Metoidioplasty (creation of penis, using clitoris)
• Nerve graft
• Penile prosthesis
• Phalloplasty (creation of penis)
• Salpingo-oophorectomy (removal of fallopian tubes and ovaries)
• Scrotoplasty (creation of scrotum)
• Testicular expanders and Testicular prosthesis
• Urethroplasty (reconstruction of male urethra)
• Vaginectomy (removal of vagina)
• Vulvectomy (removal of vulva)

Non-Genital Female to Male:

• Chest reconstruction or pectoral implants
• Electrolysis or laser hair removal
• Mastectomy
• Nipple reconstruction

Genital Surgery and Bilateral Mastectomy or Breast Reduction Surgery Documentation Requirements:

The Covered Person must provide documentation of the following for breast surgery:

• A written assessment from the Covered Person’s physician or behavioral health provider that reflects that the Covered Person meets all of the following criteria:
  • Persistent, well-documented Gender
  • Capacity to make a fully informed decision and to consent for
  • If significant medical or mental health concerns are present, they must be reasonably well controlled.
  • Highly suggested, though not required, that the covered person complete at least 3 months of psychotherapy before having the surgery

The Covered Person must provide documentation of the following for genital surgery:

• A written assessment from the Covered Person’s physician OR behavioral health provider that reflects that the Covered Person meets all of the following criteria:
  • Persistent, well-documented Gender
  • Capacity to make a fully informed decision and to consent for
  • Must be at least 18 years of
  • If significant medical or mental health concerns are present, they must be reasonably well controlled.
  • Complete at least 12 months of successful continuous full-time real-life experience in the desired gender.
  • Complete 12 months of continuous cross-sex hormone therapy appropriate for the desired gender (unless medically contraindicated).

Exclusions and Limitations for Gender Dysphoria (review pages under Summary Plan Description)

1. Treatments received outside of the United States
2. Drug therapies that are dispensed from a pharmacy
3. Drugs* for hair loss or
4. Drugs* for sexual performance for patients that have undergone genital
5. Transportation, meals, lodging or similar
6. The following listed procedures;

• Abdominoplasty
• Blepharoplasty
• Body contouring, such as lipoplasty
• Calf implants
• Injection of fillers or neurotoxins
• Hair transplantation
• Lip augmentation
• Lip reduction
• Liposuction
• Mastopexy
• Medical tattooing
• Skin resurfacing
• Reversal of genital surgery or reversal of surgery to revise secondary sex characteristics

* The drug exclusions listed above apply to drugs administered by a provider in a medical setting (including, but not limited to: office, outpatient, or inpatient facility). For drugs obtained at a pharmacy, refer to the VMware, Inc. Pharmacy page on the US Benefits webpage for specific prescription drug product coverage and exclusion terms

What if You Have a Question?

Call the UnitedHealthcare Personal Support Advisor for Gender Dysphoria telephone number at 1-800-326-9166 during regular business hours, Monday through Friday. All calls are confidential.