Sex-Trait Modification Services

For Plan year 2026, chemical and surgical modification of an individual’s sex traits through medical interventions (including gender transition services) will no longer be covered under the PSHB Program. 

We will continue to cover counseling services for diagnosed gender dysphoria. Search our online provider directory for licensed mental health providers. 

If you are mid-treatment under our Plan, you are eligible for our continuation of care exception process if you satisfy all the requirements listed below: 

• You continue to be enrolled in the same MHBP plan that you were enrolled in 2025.
• You enrolled an MHBP plan for 2026 because your 2025 plan was discontinued.
• Requirements for surgical services:
  • Preauthorization approval was completed prior to January 1, 2026; 
  • Treatment or services under approved treatment plan began before January 1, 2026; 
  • Your attending physician must complete and submit the Precertification Information Request Form and the Hair Removal Authorization Form (if applicable) to the Aetna® Precertification Department 
• Requirements for chemical regimen:
  • Preauthorization approval was completed prior to January 1, 2026; 
  • The approved chemical regimen was filled prior to January 1, 2026; and 
  • The exception form is completed and submitted to the Clinical Team for review.  You may mail or fax the exception request to:
    • Clinical FFS Team P.O. Box 981114, El Paso, TX 79998-1114 
    • 1-855-556-7066 

Our Gender Affirming Surgery Clinical Policy Bulletin outlines the procedures that are considered medically necessary. 

Individuals under age 19 are not eligible for exceptions related to services for ongoing surgical or hormonal treatment for gender dysphoria. 

If you disagree with the decision on your exception, please see Section 8 of the Plan brochure for the PSHB Appeals and Disputed Claims Process.