This policy defines medical necessity criteria and coverage for hormone therapy and gender‑affirming surgical procedures for members across multiple lines of business and follows New York State Department of Health clinical criteria. Hormone treatment is considered medically necessary when puberty has reached at least Tanner stage 2, a DSM‑5 diagnosis of gender dysphoria is documented by a licensed mental health professional, ongoing medical management is in place, and the member has adequate psychological and social support without psychiatric comorbidity that would interfere with care. For surgical treatment, members generally must be 18 years or older (exceptions for those under 18 may be allowed in exceptional circumstances with prior approval and demonstrated medical necessity), have the capacity to consent, and meet documentation requirements including mental health evaluation and, for genital surgery, evidence of at least 12 months of full‑time real‑life experience living in the preferred gender. Specific duration thresholds for hormone therapy are noted for surgical procedures (for genital surgery ≥ 12 months of appropriate hormone therapy unless contraindicated; for breast augmentation ≥ 24 months of hormone therapy when applicable).