Use this form to request approval for gender affirmation coverage.
Step 1: Complete a form.
Download the form and print it, or fill it out in Adobe Reader XI or higherOpens a new website in a new windowOpens a new website in a new window
Step 2: Ask your healthcare provider to complete the physician information section.
Step 3: Submit your request for approval.
You’ll find instructions on how to submit your claim on the form itself.