Trans* inclusion in federal employee health plans

[Freya]

I'm getting closer to choosing Kaiser.  Aetna and Kaiser are the only T related choices available in the SoCal area.  Kaiser specifically covers GRS, HRT, and Counseling.  It seems that Aetna is limited to GRS.  I haven't seen anything in the Aetna plan document regarding counseling, but in Section 5(f). Prescription drug benefits, they state that compounded bioidentical hormone replacement (BHR) therapy that includes progesterone, testosterone and/or estrogen are not covered.

I asked the Socal Kaiser Trans referral nurse about HRT and she confirmed that depending on doctor's recommendations, progesterone and injectable estrogen may be prescribed.  I asked about the cost of injectable estrogen and she said if I am self administered, I would pay the usual plan copay fees for pharmaceuticals and supplies, but if I came in to the appropriate in plan nursing station, that the injections would be provided for free.  Earlier this year, my endocrinologist prescribed injectable estrogen once a week for me.  When I went to pick up the prescription the cost was $315.00 for a 10 week supply without insurance.  It seems Kaiser's coverage for HRT is a potentially significant savings.  Personally I decided to just wait a few months and stay on oral estrogen until I change plans.

Freya

[Stochastic]

Thanks ThePhoenix for your work.

I will probably stick with BC/BS because they reached an agreement with our local hospital. I know that I should reject BC/BS out of principle because of their trans exclusions, but I have a family to think about which broadens my healthcare considerations. Overall, I have been pleased with their plan. 

For those selecting Aetna, I would be interested in how you rate their plan throughout the year as well as anything that stands out, good or bad, about their plan.

[Kaley]

ThePhoenix,
Nice job on putting together the entire chart for all 50 states!

It looks like in summary, the options are the Aetna plans, the Foreign Service Benefit plan, or Kaiser (regional).

I have also been slowly gathering info on my local Kaiser clinic and it looks like I will be going with them as well because it is the most budget friendly plan and they already have an established transgender care clinic here in Honolulu, HI.  Pretty much all of the info I have echos what you and Freya have already stated, but I will add any additional info I find.

[Freya]

I went ahead and made my selection for Kaiser today.  Aetna was the only other choice in my area without a Trans exclusion, but it seems Kaiser has much more to offer in total trans care coverage.

Freya

[Daydreamer]

Wait, so what does this mean for PA? I have the Geisinger Health Plan.

[ThePhoenix]

Wait, so what does this mean for PA? I have the Geisinger Health Plan.

Off the top of my head, I don't know about Geisinger.  But check it out on the chart.

[Daydreamer]

Off the top of my head, I don't know about Geisinger.  But check it out on the chart.

I guess I read the chart wrong because it's placed all weird, but I'm going to assume it's in the red unless I saw it wrong.

[Freya]

The Pennsylvania Geisinger Federal health Plan has not removed the "Sex transformations" exclusion.

Here's the link to the plan, exclusions are always in section 6:
http://www.opm.gov/healthcare-insurance/healthcare/plan-information/plan-codes/2015/brochures/73-849.pdf

Aetna may be your best, if not only bet in Pennnsylvania.

Here's the link to the Pennsylvania plans:

http://www.opm.gov/healthcare-insurance/healthcare/plan-information/plan-codes/2015/states/pa.asp

Just look at each plan brochure and verify in Section 6 exclusions, whether or not "Sex transformations" is there.  Just check the HMOs, since all of the nationwide plans still maintain the exclusion.

Hope this helps,
Freya

[Daydreamer]

Ugh, was so hoping they would have changed things for next year. So much for getting my hopes up.

[Freya]

Ugh, was so hoping they would have changed things for next year. So much for getting my hopes up.

Daydreamer, it's open season for Federal employees until 08DEC, so you could consider changing to a comparable Aetna plan that has removed the trans* exclusion, rather than stay with Geisinger.

Freya

[Daydreamer]

Daydreamer, it's open season for Federal employees until 08DEC, so you could consider changing to a comparable Aetna plan that has removed the trans* exclusion, rather than stay with Geisinger.

Freya

I'll think things over.

[peky]

The plane ticket is provided, as is a stipend for meals, hotel, etc.  I'm not saying for sure it is Meltser and Bowers who do the work.  It just sounds like it might be. 

As far as altruism . . . You're welcome, but it's not the least bit altruistic.  I'm losing everything.  I just had a government job offer revoked for reasons related to being trans*.  Except instead of saying it was for that, they cited what has happened to me because of who I am and then accused me of committing some sort of unspecified crime by being dirt poor.  I've been unemployed two and a half years.  I just need a reason to get out of bed.  Most of the people who say very flattering things about me don't auite grasp that.

I hope your situation improves soon...

[Freya]

I'll think things over.

If you already selected Geisinger in the 2015 Federal Employees Health Benefits Open Season, then as far as I know, you cannot make a second selection until the 2016 Open Season.  If you haven't made a selection already this open season, you have until December 8th to select a new plan.

Freya

[Daydreamer]

I'm 95% sure I'm stuck with their "Health Plus" garbage. Cool. -sighs to eternity-

[Stochastic]

More problems with our hospital . BC/BS out and made the switch to Aetna.

[Wynternight]

More problems with our hospital . BC/BS out and made the switch to Aetna.

Aetna removed the trans exclusion for the new year. I changed my insurance this open enrollment from BCBS to Aetna. This was also the first year the VA offered Aetna as a provider.