Gender-Affirming Surgery Exclusion Removed From ADOA Health Plans

Aug. 1, 2023

In June 2023, Arizona Gov. Katie Hobbs signed an executive order removing the coverage exclusion for gender-affirming surgery from the state of Arizona’s health plan. The Arizona Department of Administration (ADOA), which administers the state health plans, announced in July that the exclusion will be removed effective Friday, Aug. 11.

Beginning Aug. 11, the state of Arizona health plan covers expenses for medically necessary gender-affirming surgery. Decisions on medical necessity will follow insurance providers’ coverage guidelines for care, in accordance with the same process by which all services are submitted for coverage. The current ADOA insurance providers are Blue Cross Blue Shield of Arizona and UnitedHealthcare.

Frequently Asked Questions

Which health plans are affected by this benefit change?

This change applies to the ADOA options offered to University employees: Triple Choice Plan and High Deductible Health Plan.

The Alternative Health Plans, administered by the University of Arizona, already cover gender-affirming surgery.

Is this health plan benefit change retroactive for services provided before Aug. 11?

No. The coverage change affects only services rendered beginning Aug. 11.

How does this health plan benefit change affect the University’s Health Reimbursement Arrangement for similar services?

The University’s HRA for Gender-Affirming Surgery and Fertility Treatments, administered by Navia Benefits Solutions, will remain in place to:

  • Ensure support for services delivered prior to Aug. 11.
  • Allow the University to evaluate insurance providers' interpretations of coverage guidelines for care and medical necessity and determine if the HRA's guidelines for medical necessity bridge potential differences.
  • Maintain support for fertility treatments, which are still excluded from state of Arizona health plans.

Does this health plan benefit change count as a qualifying life event to change coverage?

No. This change is not a qualifying life event to change your existing coverage. The next benefits open enrollment for University employees will occur in October and November 2023.

Do you need more assistance?

Please contact HR Solutions.
Phone: 520-621-3660