GRS and Insurance

[Annah]

I think they are equally if not more important (especially FFS) parts of surgical transition and should be included in this sticky. I personally don't see them as anymore "cosmetic" than breast reconstruction following mastectomy, which insurance is required to pay for in New York, New Jersey, and most if not all other states.

-Lef

I understand, but this thread was concerning Insurance covered by various companies and which companies has it and which does not for srs

Also, many insurance that covers breast reconstruction after a mastectomy is due to breast tissue having to be removed after breast cancer or breasts that were so large, the patient's spine was in jeopardy. Unless you specifically pay through a private insurer, companies has those procedures as an exclusion (unless you can prove that your physical health is at stake).

I am sure that FFS and BA may be covered one day but right now, advocate groups are trying to get companies on board with SRS. FFS and BA coverages may come on the table for US companies for transgender people in about 10-15 years.

But for the time being, this sticky was made to post US companies who has SRS in their medical coverages.

[Michelle.]

Right on Sisters!!

Annah, once again thanks for sharing your "insider" knowledge.

[Annah]

Right on Sisters!!

Annah, once again thanks for sharing your "insider" knowledge.

And just think, me managing insurance claims....I would often sit there and think "what in the world would this do for me in the future other than typical medical procedures?"

Those years in the field became more valuable to me now more than ever.

[michelle666]

Right now at my work is open enrollment for our insurance plans. Tomorrow, I'm going to see if I can get the detailed coverage documents for each policy. There must be something in at least one of the policies. On the Human Rights Campaign site, my company is listed in the Best Places to Work 2011. The coverage is a bit confusing.
My company is listed like this;

TRANSGENDER BENEFITS
Benefits

                                                                      Insurance Available to Employees                    Transgender Treatment Covered

Short-term Leave After Surgical Procedure         X                                                                      x
Mental health counseling                                 x                                                                      x
Hormone therapy                                         x                                                                      -
Medical visits                                                 x                                                                      -

[Annah]

Right now at my work is open enrollment for our insurance plans. Tomorrow, I'm going to see if I can get the detailed coverage documents for each policy. There must be something in at least one of the policies. On the Human Rights Campaign site, my company is listed in the Best Places to Work 2011. The coverage is a bit confusing.
My company is listed like this;

TRANSGENDER BENEFITS
Benefits

                                                                      Insurance Available to Employees                    Transgender Treatment Covered

Short-term Leave After Surgical Procedure         X                                                                      x
Mental health counseling                                 x                                                                      x
Hormone therapy                                         x                                                                      -
Medical visits                                                 x                                                                      -

Best places to work for LGBT people does not mean SRS is covered by that company. It means that your company is very open and embraces LGBT people. I will explain what that chart means for you that was put in place by your company:

According to your chart, your company has a disability insurance contract that covers disability leave from SRS (which is very very good. Many companies do not have that in their disability language).

Mental Health Counseling means that your doctor can diagnose your visits as transgender related and your insurance will cover it. Typically, people who are insured has their therapist list your visits as "clinical depression" so you can be covered while doing your WPATH requirements.

Your company does not cover insurance that facilitates the prescription costs of estrogen, anti androgen, and other medications a doctor would prescribe to you during your transition.

Your company does not cover the costs of endocrinology appointments or any lab work that is in relation to hormonal replacement therapy. Your policy in this same relation, also does not cover orchi under transgender diagnosis.

Based on the last two sections of your company's chart, I am pretty sure they do not cover SRS. But nevertheless, call your HR Director. Their policies may have changed since HRC's last publication.

[Michelle.]

Keep in mind the Target/WalMarts of the world 'script drug plans. Estrogen and Spiro are on there.
Also run a spreadsheet. At what point are you better off getting the cheapest HMO and paying out of pocket for some things. Does work offer a Health Savings Account? Etc etc.

[michelle666]

Best places to work for LGBT people does not mean SRS is covered by that company. It means that your company is very open and embraces LGBT people. I will explain what that chart means for you that was put in place by your company:

According to your chart, your company has a disability insurance contract that covers disability leave from SRS (which is very very good. Many companies do not have that in their disability language).

Mental Health Counseling means that your doctor can diagnose your visits as transgender related and your insurance will cover it. Typically, people who are insured has their therapist list your visits as "clinical depression" so you can be covered while doing your WPATH requirements.

Your company does not cover insurance that facilitates the prescription costs of estrogen, anti androgen, and other medications a doctor would prescribe to you during your transition.

Your company does not cover the costs of endocrinology appointments or any lab work that is in relation to hormonal replacement therapy. Your policy in this same relation, also does not cover orchi under transgender diagnosis.

Based on the last two sections of your company's chart, I am pretty sure they do not cover SRS. But nevertheless, call your HR Director. Their policies may have changed since HRC's last publication.

I got my plan descriptions from my HR department yesterday, they're only 3 pages long and don't go into anything trans. How would I find out what exactly is covered, just call the insurance company?

While looking at all this yesterday, I got the details on the disability leave for surgery. I can take 13 weeks at full pay, then 13 more at 50% pay and then up to a year more at 50% on long term leave. I also found out that we also have a legal plan for all civil matters, so I signed up for that. At $3 a week, it's worth it.

[Annah]

yes, usually the fine print isn't in the booklets you get at work so you will have to call....or you can tell me where you work and I can tell you right away if your company covers srs

[michelle666]

yes, usually the fine print isn't in the booklets you get at work so you will have to call....or you can tell me where you work and I can tell you right away if your company covers srs

i work for the interpublic group. We have Aetna and UnitedHealthcare. Wiht united, we have two PPO choices and Aetna, I think it's and EPO or something like that.

[Annah]

i work for the interpublic group. We have Aetna and UnitedHealthcare. Wiht united, we have two PPO choices and Aetna, I think it's and EPO or something like that.

Unfortunately, Interpublic Group of Companies Inc does not have SRS/GRS/GCS on their policy.

Aetna has this procedure on their list of coverable procedures, but Interpublic Group of Companies Inc has chosen to make it an exclusion at this time.

You should contact your HR to discuss any opportunities to add SRS/GRS/GCS to the policy when benefits are renewed.

[michelle666]

Unfortunately, Interpublic Group of Companies Inc does not have SRS/GRS/GCS on their policy.

Aetna has this procedure on their list of coverable procedures, but Interpublic Group of Companies Inc has chosen to make it an exclusion at this time.

You should contact your HR to discuss any opportunities to add SRS/GRS/GCS to the policy when benefits are renewed.

Thanks for checking! I had a feeling that they didn't. It is nice that they do cover therapy and the leave after surgery though. The 13 weeks leave at full pay and 13 at half pay is going to help a lot. I was planning on saving money to get me through the recovery period, which would make me put surgery off for an extra year.

[Annah]

Thanks for checking! I had a feeling that they didn't. It is nice that they do cover therapy and the leave after surgery though. The 13 weeks leave at full pay and 13 at half pay is going to help a lot. I was planning on saving money to get me through the recovery period, which would make me put surgery off for an extra year.

yup. Make sure you sit down with your HR concerning your Disability Insurance too. Get to know your disability contract very intimately before going out on leave. I would also heavily suggest to call your disability carrier directly and talk to them before the procedure is even done.

When I was with Liberty Mutual I cannot tell you how many times the HR did not know their contract that they put together with us. Some things I would ask your disability provider:

1. The contract covers disability leave for sexual reassignment surgery correct?
2. Are there any special provisional requirements to make myself eligible for disability after the surgery or is there anything I should know about that could hinder the approval process of the claim?
3. Is the disability contract valid if my surgery was done out of the country? (if you are getting it done out of the country)...if this is the case make sure you communicate with your foreign doctor about sending your medical records promptly to your disability provider.
4. Make sure you know your length of time at your job, make sure your fulltime status is known and understood and make sure your 13 weeks full pay and 13 weeks half pay will apply to you.

About step number 4, your time out will be determined by your job occupation activity level. If you worked in a factory doing heavy machinery, your time out will be longer. If you sit all day with occasional walking (Sedentary) then your time out will be much shorter. 13 weeks full and 13 weeks half simply means this is the maximum amount of time as provided in the contract that your disability company will pay for. 26 weeks is for those who had MAJOR surgery with a Heavy Job occupation (such as a Quintiple Heart Bypass Surgery and a rotator cuff surgery done on the same person in the same time). The maximum is also for those who have stage four cancer where they know that the heavy chemo treatments and therapy will put them out of work (and possibly terminal).

If you have a Sedentary job position where you do occasional walking, your time out of work is typically Five to Eight week for SRS. If you think you need more time out then your disability carrier will need medical documentation from doctors to medically prove you are unable to meet your job requirements. The longest I had approved anyone for SRS was 12 weeks because she had Vaginal Prolapse, meaning her bladder pushed its way into the vaginal wall and obstructed her urine. Under those circumstances, then 12 weeks is granted (she had medical documentation to prove the complications).

Remember....26 weeks of disability access does not mean you will get 26 weeks. 26 weeks is for worse case scenarios and very serious surgery where recovery time is VERY long to the point where long term disability may be needed.

[Dana_H]

Just wanted to mention that just because a particular insurer covers SRS that does not mean a particular company's plan with that insurer will include SRS coverage; it depends on what type of corporate insurance plan the company was willing to pay for.  In my case, my employer offers 3 different levels of coverage through BCBS, but none of them include coverage for SRS even though BCBS does have such coverage available as an option for its corporate customers. (I'm nowhere near ready for SRS, but I wanted to know what my plan included. I'm hoping to be working somewhere (anywhere) else by the time SRS entires my timeline, so no biggie for me just now.)

Definitely read your detailed benefits explanation. If necessary, call the insurer and ask them to clarify the specifics of the plan you are on with respect to SRS.  Sometimes, you really have to push to find out if SRS coverage is in your plan and what the criteria are for invoking that coverage.

[Lallie]

Annah, thanks so much for bringing information to the huddled masses. I have a multi-employer/union health plan which uses Blue Cross Anthem, Plan 040, but my primary is Medicare. What can you tell me about my SRS coverage?

Lallie

[michelle666]

Last week I asked my HR person for the detailed plan description. They pretty much refused to give it to me. They said "that will be a couple of hundred pages" you dont need all that. 

[Annah]

Annah, thanks so much for bringing information to the huddled masses. I have a multi-employer/union health plan which uses Blue Cross Anthem, Plan 040, but my primary is Medicare. What can you tell me about my SRS coverage?

Lallie

Even Blue Cross plan 040 has the options to be tailored as to what can be included or excluded. The best thing to do is PM your company's name and I can tell you if they cover SRS or any other transgender benefits.

[Annah]

Last week I asked my HR person for the detailed plan description. They pretty much refused to give it to me. They said "that will be a couple of hundred pages" you dont need all that. 

yeah they probably wont. It would be considered a waste of resources to them (i.e., paper).

Your company does not cover SRS surgery specifically, but the best thing you can do (if you need to know the exact coverages) is to contact your healthcare insurer and ask them questions about what you want to know about coverages.

From looking at your company, you have coverage for short term disability leave from SRS surgery or gender related depression and you have coverage for gender related mental health counseling. You do not have coverage for HRT and surgery transgender related procedures.

[Flan]

Last week I asked my HR person for the detailed plan description. They pretty much refused to give it to me. They said "that will be a couple of hundred pages" you dont need all that. 

easier to ask for certificate of coverage since it's usually less then 50 pages and shows exactly what's covered or not

[Melody Maia]

My ex told me the other day that the payroll/human resources company, Automatic Data Processing (ADP) now covers "transgender stuff." Don't know if that includes SRS, but I hope it does. ADP uses Aetna. A friend who is employed by Sprint also told me that this coming year they will have transgender coverage.

[Annah]

My ex told me the other day that the payroll/human resources company, Automatic Data Procession (ADP) now covers "transgender stuff." Don't know if that includes SRS, but I hope it does. ADP uses Aetna. A friend who is employed by Sprint also told me that this coming year they will have transgender coverage.

correct, ADP has added transgender medical benefits, including srs to their 2012 policy