Gender-Affirming Benefits

SHIP Gender-Affirming Benefits 

Scheduling Appointments at UHS

  • Gender-affirming services and hormone therapy appointments with a primary care provider can be scheduled through the eTang portal. Visit the Transgender Care page for more details.
  • If you need assistance, call Clinic 3 at (510) 643-7110 and ask to speak with a clinic nurse. The clinic nurse can arrange appointments and prepare you for your visit.  

Referrals 

If you receive a referral from a UHS provider, a member of the SHIP Trans Care Benefits Team will contact you by eTang secure message to schedule a phone consultation to discuss the SHIP gender-affirming benefits, pre-certification requirements, locating in-network providers and go over any questions you may have. 

Pre-certification* is required for the following services: 

  • Hysterectomy 
  • Mastectomy (top surgery) 
  • Breast augmentation (augmentation mammoplasty) 
  • Gender-conforming facial surgery 
  • Gender-confirmation (reassignment/bottom) surgery
  • Fertility preservation 
  • Travel expenses 

*Pre-certification is required prior to receiving the services. Failure to obtain prior-approval will result in claims being denied. To request pre-certification, the provider of service will need to submit the request form with supporting medical documentation to the SHIP office. 

Pre-certification is not required for the following services:

  • Hormone therapy
  • Electrolysis or laser hair removal of full body (as of 8/1/24)
  • Tracheal shave
  • Vocal training* (speech therapy)

*After the 12th visit per plan year, services are subject to pre-certification and medical necessity review. 

Estimated Costs* for Common Surgeries

  • Mastectomy (top surgery): $18,000 - $23,000
  • Hysterectomy: $25,000 - $37,000
  • Orchiectomy: $11,000
  • Augmentation mammoplasty (breast augmentation): $16,000 - $24,000
  • Gender-confirmation (reassignment/bottom) surgery, including metoidioplasty, vaginoplasty, phalloplasty: $25,000 - $150,000

*Please use these estimates as suggestions only; costs vary widely. Estimated prices are based on case rates, which may include costs for services after the surgery, such as follow-up care if needed.

SHIP members are responsible for the $450 deductible and any applicable co-pay and co-insurance, up to the out-of-pocket maximum of $3200 per plan year for in-network services. More benefit and coverage details can be found on the gender-affirming benefits flyer. Pre-certification is required for most care.

If you don't have SHIP

Questions?

  • Contact the SHIP Trans Care Benefits Team at (510) 642-5700 or by sending a secure message in the eTang portal.  

More Information