Assistance with Treatment for Gender Dysphoria Sample Clauses

Assistance with Treatment for Gender Dysphoria. Gender Dysphoria causes gender identity-related distress that some transgender and nonbinary people experience which can be treated through psychiatric, medical, and surgical treatments. Gender Dysphoria is a medical diagnosis recognized in the Diagnostic and Statistical Manual of Mental Disorders (“DSM-V”), published by the American Psychiatric Association. Transgender identity is not the pathology; the dysphoria that stems from distress caused by the societal marginalization of gender variance is what requires medical treatment. LSNYC acknowledges the current health insurance landscape limits access to medically necessary care for Gender Dysphoria. Accordingly, LSNYC commits to self-insuring, or otherwise providing for, medically necessary treatment of Gender Dysphoria. LSNYC will provide reimbursement to those enrolled in a LSNYC group health insurance plan for all Eligible Medical Expenses for Gender Dysphoria Treatment up to an annual maximum of $25,000 per person. Eligible Medical Expenses are expenses incurred for medical care related to Gender Dysphoria Treatment for which reimbursement has been denied by LSNYC’s group insurance plans. Eligibility for the fund shall require: (1) Written denial of coverage by one of LSNYC’s health insurance plans, including proof of denial of an internal appeal as described in LSNYC’s Health Reimbursement Arrangement Plan for Gender Affirming Care (HRA), or failure to receive a decision from the health insurance plan within 60 days of appeal; (2) Proof of unreimbursed costs following provision of services; and (3) Written documentation of medical necessity in the form of a primary care or mental health provider’s note confirming a diagnosis of Gender Dysphoria and the necessity of the treatment requested, guided by the WPATH protocols. LSNYC-provided financial assistance may be used to cover ancillary costs related to medical care which may include, but are not limited to: Other FSA-eligible medical expenses reimbursable under IRS Code Section 213(d), including travel and lodging costs related to medical care; prescriptions; consultation fees; court costs and legal fees related to medical care; and prerequisite fees such as pre- treatment counseling. Written documentation to substantiate the expense must be submitted in order to receive reimbursement. Upon request, and if you are waiting for a decision on appeal from a denial of coverage by one of the group plans offered by LSNYC, the Third Party Administrator will ...