you do not need to work for sears to get this insurance it is available as private purchase threw anthems site here are the policies related to gender reassignment coverage as pulled from their policies page but you also need to remember that most grs surgeons do not currently take insurance so you will still have to pay up front then file for reimbursement.
Jessi
Medically Necessary:
Gender reassignment surgery* is considered medically necessary when all of the following criteria are met:
The individual is at least 18 years of age; and
The individual has been diagnosed with the Gender Identity Disorder (GID) of transsexualism, including all of the following:
The desire to live and be accepted as a member of the opposite sex, usually accompanied by the wish to make his or her body as congruent as possible with the preferred sex through surgery and hormone treatment; and
The transsexual identity has been present persistently for at least two years; and
The disorder is not a symptom of another mental disorder or a chromosomal abnormality; and
The disorder causes clinically significant distress or impairment in social, occupational, or other important areas of functioning; and
For those individuals without a medical contraindication, the individual has undergone a minimum of 12 months of continuous hormonal therapy when recommended by a mental health professional and provided under the supervision of a physician; and
The individual has completed a minimum of 12 months of successful continuous full time real-life experience in their new gender, with no returning to their original gender, including one or more of the following:
Maintain part- or full-time employment; or
Function as a student in an academic setting; or
Function in a community-based volunteer activity; and
The individual has acquired a legal gender-identity-appropriate name change; and
The individual has provided documentation to the treating therapist that persons other than the treating therapist know that the individual functions in the desired gender role; and
Regular participation in psychotherapy throughout the real-life experience when recommended by a treating medical or behavioral health practitioner; and
Demonstrable knowledge of the required length of hospitalizations, likely complications, and post surgical rehabilitation requirements of various surgical approaches; and
Demonstrable progress in consolidating one's gender identity, including demonstrable progress in dealing with work, family, and interpersonal issues resulting in a significantly better state of mental health (this implies satisfactory control of problems such as sociopathy, substance abuse, psychosis, suicidality, for instance); and
A letter** from the individual's physician or mental health provider, who has treated the individual for a minimum of 18 months, documenting the following:
The individual's general identifying characteristics; and
The initial and evolving gender, sexual, and other psychiatric diagnoses; and
The duration of their professional relationship including the type of psychotherapy or evaluation that the individual underwent; and
The eligibility criteria that have been met and the physician or mental health professional's rationale for surgery; and
The degree to which the individual has followed the eligibility criteria to date and the likelihood of future compliance; and
Whether the author of the report is part of a gender identity disorder treatment team; and
A letter** from a second physician or mental health provider familiar with the individual's treatment and the psychological aspects of Gender Identity Disorders, corroborating the information provided in the first letter (see #10 above); and
When one of the signatories on the letters indicated above is not the treating surgeon, a letter from the surgeon confirming that that they have personally communicated with the treating mental health provider or physician, as well as the individual, and confirming that the individual meets the above criteria, understands the ramifications and possible complications of surgery, and that the surgeon feels that the individual is likely to benefit from surgery.
* Gender reassignment surgery may include any of the following procedures:
Male-to-Female Procedures
Orchiectomy
Penectomy
Vaginoplasty
Clitoroplasty
Labiaplasty
Female-to-Male Procedures
Hysterectomy
Salpingo-oophorectomy
Vaginectomy
Metoidioplasty
Scrotoplasty
Urethroplasty
Placement of testicular prostheses
Phalloplasty
** At least one of the professionals submitting a letter must have a doctoral degree (Ph.D., M.D., Ed.D.,
D.Sc., D.S.W., or Psy.D) and be capable of adequately evaluating co-morbid psychiatric conditions. One letter is sufficient if signed by two providers, one of whom has met the doctoral degree specifications, in addition to the specifications set forth above.
Not Medically Necessary:
Gender reassignment surgery is considered not medically necessary when one or more of the criteria above have not been met.
