SRS Insurance Coverage - Please help! in IL

[Eccentric Moe]

Hey peeps,

I am struggling to find an individual health insurance policy in IL that doesn't outright exclude SRS.  Specifically, I am looking at getting meta w/hook up.

All of the online resources I've found link to dead ends.  Primarily this one:  http://www.hrc.org/resources/entry/finding-insurance-for-transgender-related-healthcare

All of those companies that offer IL plans I have called for specifics and SRS is outright excluded.  I keep hearing that employer plans are generally more comprehensive and can include SRS coverage.  Unfortunately, the plan I get through my employer does not.

Does anyone here have experience getting SRS coverage as an IL resident?  How did you folks get SRS covered, if at all? I feel like I am getting screwed by the state I live in! 

Please share your experiences, thanks.

Moe

[zero.cool.crash.override]

This post: https://www.susans.org/forums/index.php/topic,176991.0.html links to a chart showing trans inclusion on federal employee insurance, listing them state by state.  I realize that you are looking for an individual plan rather than federal employee plan, so this might not be very helpful.  The chart shows Aetna as the only company listed for IL which does NOT have a trans exclusion, so they at least sometimes cover trans.  And on the page you mentioned (hrc.org), Aetna's link says:

Aetna considers gender reassignment surgery medically necessary when all of the following criteria are met:
[...]
III.Requirements for genital reconstructive surgery (i.e., vaginectomy, urethroplasty, metoidioplasty, phalloplasty, scrotoplasty, and placement of a testicular prosthesis and erectile prosthesis in female to male; penectomy, vaginoplasty, labiaplasty, and clitoroplasty in male to female)
A.Two referral letters from qualified mental health professionals, one in a purely evaluative role (see appendix); and
B.Persistent, well-documented gender dysphoria (see Appendix); and
C.Capacity to make a fully informed decision and to consent for treatment; and
D.Age of majority (age 18 years and older); and
E.If significant medical or mental health concerns are present, they must be reasonably well controlled; and
F.Twelve months of continuous hormone therapy as appropriate to the member's gender goals (unless the member has a medical contraindication or is otherwise unable or unwilling to take hormones); and
G.Twelve months of living in a gender role that is congruent with their gender identity (real life experience).

I don't live in IL, nor do I have any specific experience with SRS coverage.  Sorry I couldn't be more help. 

[aleon515]

Your state has nothing to do with it. Unless you live in one of 4-5 states which do not allow exemptions on trans. Sadly you do not. In such a case, it is not the insurance company. There may be insurance companies which never cover trans related stuff but not sure which they are. It's all the employer. So pretty much to get SRS you must be with a large company and/or a very liberal one. So something like Google will carry SRS coverage but Hobby Lobby will not. I'd say generally tech companies like to be in the lead on things. It's getting more common, as insurance companies find out it really will not break them.


--Jay

[Eccentric Moe]

@ zero.cool.crash.override

Despite what the hrc.org documentation says, I could not confirm any SRS coverage from Aetna.  I called them twice and spoke to two different people, and send them an email.  All three times I was told they do not have that coverage for individual policies, even after pushing that I was going to get whatever evaluations & letters necessary and stating all the other criteria I meet.  Any of the insurance companies on the hrc.org site that offer ins in IL, do not have any individual plans that provide coverage for SRS.  At least based on all of the phone calls I made.

The closest I got to confirming was Humana.  In their summary of benefits they say the cover genital surgery if ordered by a healthcare professional.  However, the summary of benefits doesn't guarentee coverage, the policy documents do.  She couldn't check the policy documents for 2015 since they aren't available yet so I asked her to check for 2014 to compare.  It outright said it was excluded regardless of diagnosis.  And of course the summary of benefits for 2014 said the same thing 2015 did.  So... I do not want to spend 3x the amount on insurance for a gamble.

@ aleon515 

I think you are right.  From what I've gathered, it has to be a group plan. 

I've reached out to the HR department in my company to request this coverage be added to the group plan.  We'll see if anything comes of it.  It might take a few years to become available.  I am aiming to get a meta before that, but even if I don't benefit from it, then the next trans person who comes along will.

Thank you two for sharing your insights.