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   Health  By Deborah Stayman


Check out new Empire Plan benefits

By DEBORAH STAYMAN

As we approach open enrollment for your 2020 health insurance plan, the Empire Plan has announced two new benefits taking effect in 2019.

Gardasil

Adults up to age 45 are now covered for the Gardasil vaccine under the Empire Plan. And it’s free if you use a network provider.

The Empire Plan, effective October 1, extended the age range for coverage of the Gardasil 9 Human Papilloma Virus (HPV) vaccine as a preventive care service for men and women through age 45. The Plan has been covering the Gardasil 9 vaccine as a preventive care service for enrollees ages 9-26.

In October 2018, the FDA approved the Gardasil 9 vaccine for expanded use by men and women ages 27–45 years old. Consequently, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) recommended extending the age range for coverage of the Gardasil 9 vaccine as a preventive service through age 45. This age range extension applies only to the Gardasil 9 vaccine, not to any of the other HPV vaccines. The CDC adopted the ACIP recommendation in June 2019, to be effective by October 1, 2019.

Preventive care services required under the Affordable Care Act (Obama Care), which includes the Gardasil 9 HPV vaccine, are covered at no cost share to enrollees when a network provider is used.

Gender reassignment

Effective September 16, the Empire Plan began covering medically necessary surgery and other medical treatments related to gender reassignment.

The coverage includes gender reassignment surgery and any other surgeries, services and procedures associated with gender reassignment (including those performed to change an enrollee’s physical appearance to more closely conform secondary sex characteristics to their identified gender) if a behavioral health provider determines the surgery or procedure is medically necessary.

A behavioral health provider, who must be licensed by the state in which they practice and experienced in treating gender dysphoria, must provide a written assessment documenting that the enrollee has a diagnosis of gender dysphoria, the capacity to make a fully informed decision and to consent for treatment, and is 18 years of age or older.

Benefits are available under the Participating Provider and Basic Medical programs. While not required, a predetermination review, also known as a preservice claim determination, is available.

Coverage for gender dysphoria treatment also includes cross-sex hormone therapy, puberty- suppressing medications and laboratory testing to monitor the safety of hormone therapy.

More information is provided in the Empire Plan Certificate Amendment dated September 16, 2019.


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