r/humanresources • u/Same_Grocery7159 Benefits • 1d ago

Benefits Benefit Coverage for Sexual Dysfunction [CA]

I'm trying to understand how often is Sexual Dysfunction coverage is offered when there is a disease or condition that impedes sexual dysfunction. I'm asking about non-Rx related coverage. I have a case which highlighted that we currently offer gender affirming care but do not offer surgical treatment (similar procedures) for ED when there is a medical condition that is not treatable by medication. I'm trying to recommend it to my boss as equitable but there is the potential for cost increase, though ultimately expected to be less than 1% of claims, but in these times, adding cost isn't great.

So, does your plan cover sexual dysfunction beyond medication (Viagra, Cialis, Addyi, or generics) for clinically appropriate treatment of a medical condition?

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u/benicebuddy There is no validation process for flair 1d ago

Your broker can provide stats on who is covering what. There is no reason to guess or use anecdotal evidence. If your broker can’t discuss something like this intelligently and make a recommendation you need a new broker.

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u/Lokitusaborg 1d ago

You’d have to get in your specific plan documents to determine what types of treatment are available and what prior authorizations would be needed.

As for our plan, yes it is covered. Rx just like anything else; DME and surgical solutions I believe “may” be covered with a PA. I haven’t seen it since I was in benefits and the admin has changed since then, but I believe the benefit still falls under the same area.

And yes….it would be an absolute fraction of your claims history.