Accessing Gender-Affirming Care and Coverage

From the beginning, our mission at Sana has been to make quality healthcare accessible, affordable, and understandable — and that includes access to gender-affirming care.

All Sana plans are self-insured, which means they are not subject to state insurance mandates. Because of this, our flexible network continues to offer access to the highest quality of care, including travel benefits, regardless of plan type or geographic location. 

Transgender Sana members may seek all, none, or some of the following interventions to help affirm their own gender identity. Please note that a diagnosis of gender dysphoria and prior authorization are required. 

Medical Care

Gender-affirming hormone therapy is the most common gender-affirming intervention. For PPO Plus Plans, generic hormone therapy is $10 per refill. Please see the SmithRx Formulary for specific pricing information by brand. Members of PPO Plus HSA (H) plans will owe the full cost prior to meeting their deductible and can reach out to SmithRx for an estimate of their pre-deductible drug costs.

Surgical Care

Specific surgical care coverage is defined by your plan. In general, In general, Sana plans cover 50–100% post-deductible of the following services and interventions to help affirm gender identity, when Medically Necessary:

• Augmentation mammoplasty
• Clitoroplasty
• Feminizing vaginoplasty
• Hysterectomy/Salpingo-oophorectomy
• Labiaplasty
• Laser or electrolysis hair removal in advance of genital reconstruction
• Masculinizing chest surgery ("top" surgery)
• Masculinizing phalloplasty/scrotoplasty
• Metoidioplasty (clitoral release/enlargement, may include urethral lengthening)
• Orchiectomy
• Penectomy
• Urethroplasty
• Thyroid cartilage reduction/reduction thyroid chondroplasty/tracheal shave
• Vaginectomy
• Voice lessons and/or voice therapy
• Voice modification surgery
• Vulvectomy

Not Covered
Certain cosmetic ancillary procedures are not covered, even when performed as part of surgical treatment for gender dysphoria, including but not limited to:

• Abdominoplasty
• Blepharoplasty
• Calf implants
• Cheek, chin, and nose implants
• Collagen injections
• Face lift, forehead lift, or neck tightening
• Facial bone remodeling for facial feminization
• Laser or electrolysis hair removal not related to genital reconstruction
• Hair transplantation
• Lip reduction/enhancement
• Liposuction
• Mastopexy
• Rhinoplasty

Important: Benefits and coverage are defined by your Summary Plan Description (SPD).