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LGBTQIA+ Health
We're with you
Lesbian, gay, bisexual, transgender, queer or questioning, intersex, and asexual people have a right to safe, affordable healthcare. Your medical plan benefits are available to help you get the care you need from a provider you trust.
Find affirming healthcare providers
We know having affirming providers is important for all your care, from primary care providers to dentists to surgeons. If you’re looking for a provider who is supportive and nonjudgmental for all services, you can find one in our Find a Doctor tool.
- For LGBTQIA+ friendly providers, sign in to your account and in the tool, search “LGBTQIA+ affirming.”
- For providers who offer gender-affirming care, sign in to your account and search “gender affirming.”
- Other resources for finding gender-affirming care include:
Before setting appointments with a provider, confirm your provider is in network by going to our provider directory.
For additional support, contact customer service at the number on the back of your ID card.
Preventive care
Even if you feel fine, regular checkups—about once a year—are important to maintaining good health. Preventive care is covered at 100percent, which means no out-of-pocket cost to you.
What can you expect at a preventive visit?
- Questions about your mental and physical health, health history, and current concerns
- Vital sign check
- General head-to-toe exam
- Sexual organ and/or breast exam
- Screenings for cholesterol, blood sugar, and sexually transmitted illnesses
- Vaccinations, if recommended
It's important to get the cancer screenings recommended for the sex you were assigned at birth or as recommended by your doctor. This may include screenings for breast cancer, cervical cancer, colon cancer, and prostate cancer.
If you discuss a symptom, injury, or condition, you may be charged for a regular office visit.
Mental health care
Most health plans cover care for mental health and substance-use disorders with a copay. This includes counseling and psychotherapy that can support you with the following:
- Stress and anxiety
- Self-confidence
- Trauma
- Life's challenges
- Gender transition
- Dependence on substances such as alcohol or opioid
- Diagnosed mental health conditions such as major depression
Community and family support affects health and lessens the risk of depression and anxiety. A primary care physician or counselor can help you find support in your community.
HIV PrEP therapy
Those identified as high risk for HIV infection have access to certain HIV preexposure prophylaxis (PrEP) medication at no cost when used as a preventive measure. These include the following medications:
- Emtricitabine-tenofovir disoproxil — Considered preventive when used for HIV PrEP.
- Descovy and Truvada — Considered preventive when used for HIV PrEP if you have previously tried emtricitabine-tenofovir disoproxil in the last two years.
Gender-affirming services
Understanding your benefits
Gender-affirming care includes services that support the process of aligning your gender with your gender identity. Gender-affirming services may include:
- Surgical care
- Masculinization and feminization services
- Prescription drugs, including hormones
- Mental health services
Coverage and conditions, including age requirements, can vary by plan. Sign in to your account to check your benefit booklet to confirm benefits and coverage. If you don’t see specific requirements in your benefit booklet, contact us.
Criteria for gender-affirming care varies by service.
For general information about gender-affirming benefits, read the FAQ.
Personal health support
Our personal health support clinicians can help you navigate the process and help you get the care that’s right for you. To talk with a personal health support clinician, email healthhelp@premera.com or call 888-742-1479 (TTY:711). We are available to take your call Monday through Friday, 8 a.m. to 7 p.m. and Saturdays 9 a.m. to 1 p.m.
Receive gender-affirming care
Most gender-affirming services require prior authorization.
- Your provider will submit a prior authorization request for services along with relevant medical records to Premera.
- Premera clinicians—such as nurses, behavioral health clinicians, and physicians—review the request to ensure requested services are covered by your plan and meet criteria.
- If approved, you can schedule your care. Your standard copays, coinsurance, and deductible will apply.
- If denied, you’ll receive a letter that explains why it was denied and what you can do next, including how to appeal the decision.
You can keep your out-of-pocket costs as low as possible by choosing a provider in your plan network.
If your doctor or clinic is out of network and you pay for your services out of pocket, you can submit a claim form to us for reimbursement. Prior authorization requirements still apply. Include all the procedure and diagnosis codes, as well as costs for each procedure, and medical records so your claim can be processed as quickly as possible.
Note: Some health plans may not have out-of-network benefits. To check your out-of-network coverage, Sign in to your account and check your benefit booklet or contact customer service.
Need support?
Customer service: Our customer service representatives can answer your questions about benefits and costs. Call the number on the back of your ID card.
Personal health support: Our personal health support team can assist with complex courses of treatment, such as gender-affirming care. Call 888-742-1479.
Benefits under your health plan may differ, so refer to your benefit booklet for information on what your specific health plan covers.
Your health plan covers preventive care services as required by state and federal law. For more information, please review the "A" and "B" rated services on the United States Preventive Services Task Force, immunizations recommended by the Centers for Disease Control and Prevention and preventive care and screening recommended by the Health Resources and Services Administration. See the list on healthcare.gov.