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Gender affirmation form

Have coverage through your employer or plan sponsor? You’re in the right place.

If you bought coverage through your advisor, use our personal insurance forms instead.

Request pre-approval

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 higher - Opens in a new window  (not your browser) and save. Complete the plan member section.

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.

Not what you’re looking for? Find the forms you need.

I have coverage through my employer

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I bought coverage through an advisor

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