Effective July 1, endowed health plans will begin to cover new benefits for transgender, transsexual and gender nonconforming enrollees and those diagnosed with autism spectrum disorder.

“On an ongoing basis, Benefit Services continues to evaluate additional coverage and new services that help advance our caring community,” said Paul Bursic, senior director of Benefit Services. “This additional coverage supports our diverse faculty, staff and their families.”

Transgender Benefits

New coverage includes therapy and certain medical procedures related to gender identity confirmation procedures. “These health plan changes bring Cornell into a group of vanguard institutions that show support for the unique needs of the lesbian, gay, bisexual and transgender (LGBT) community,” said Bursic.

The endowed health plans have covered some aspects of transgender health, but not hormone therapy or gender confirmation surgery. Given the serious nature of these procedures, coverage will be limited to persons at least age 18 who have been medically evaluated and received preparatory treatment.

The Aetna Clinical Policy Bulletin guides the medically necessary treatment protocol; treatments that are considered cosmetic in nature are not covered.

The Empire Health Plan – a New York state-supported plan used by the contract college faculty and staff – does not offer gender confirmation surgery and several other therapeutic treatments. Benefit Services does not anticipate an early adoption of these therapies in the Empire Health Plan.

More detail can be found in the Aetna Clinical Policy Bulletin #0615.

Autism Spectrum Disorder

The autism spectrum disorder (ASD) and other pervasive developmental disorders will be covered and will include applied behavioral analysis (ABA) and behavioral therapy.

There will be no calendar year or lifetime maximum limits put on the amount the plan will cover for ABA therapy, but other limitations will apply. For example, services such as psychological testing, neuropsychological testing and ABA will need to be precertified and authorized. Refer to the Clinical Policy Bulletin for a more complete list of covered services and any applicable exclusions. 

The Empire Health Plan began covering ASD in January under a state-sponsored mandate. It limits the annual cost of ABA to $45,000, which may be lifted in the future under national health insurance reform standards.  

For questions or additional information, contact Benefit Services at 607-255-3936, visit the Benefits Services website or contact Aetna directly, at 877-371-2007.