New Directive from the OPM for Transgender Federal Employees

[Wynternight]

SUBJECT: Covered Benefits for Gender Transition Services
Effective January 1, 2016, no carrier participating in the Federal Employees Health Benefits Program may have a general exclusion of services, drugs or supplies related to gender transition or "sex transformations."
This letter clarifies OPM's earlier guidance recognizing the evolving professional consensus that treatment may be medically necessary to address a diagnosis of gender dysphoria.
If you have any questions, please contact your Contract Specialist.

Great news!!!!

[Tysilio]

Yes, indeed!

[Kara.A.I]

Would this apply to VA Medical Facilities as well?!?! They currently deem any transition related surgery, not including HRT, cosmetic and won't cover it.


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[Wynternight]

Would this apply to VA Medical Facilities as well?!?! They currently deem any transition related surgery, not including HRT, cosmetic and won't cover it.


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Aetna covers SRS and is one of the choices as a VA employee, BCBS does not. I'm calling the OPM tomorrow to report BCBS being out of compliance.

[Kara.A.I]

Thank you for your response Wynternight. I'm actually not an employee but a Veteran. I'm sorry for the confusion. I hope you get a good response from them! I've been having plenty of issues with my local VA Medical Center.

-Kara


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[Wynternight]

Thank you for your response Wynternight. I'm actually not an employee but a Veteran. I'm sorry for the confusion. I hope you get a good response from them! I've been having plenty of issues with my local VA Medical Center.

-Kara


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Ok, gotcha. I'm not sure where the VA stands on care for vets at this time. I know hormones are covered but I'm not sure about anything else.

I contacted the union today and gave them copies of the OPM mandate for this year and the clause excluding SRS from the 2016 benefits guide. The union is going to contact our state Senator so we'll see what happens.

[Kara.A.I]

Wynternight :
Awesome, I wish you the best of luck!! I hope it goes smoothly and gets fixed asap. I'm going to be working on getting my local VA up to standards.


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[FTMax]

I contacted the union today and gave them copies of the OPM mandate for this year and the clause excluding SRS from the 2016 benefits guide. The union is going to contact our state Senator so we'll see what happens.

Thank you for doing this!

[Alana_Jane]

Ok, gotcha. I'm not sure where the VA stands on care for vets at this time. I know hormones are covered but I'm not sure about anything else.

I contacted the union today and gave them copies of the OPM mandate for this year and the clause excluding SRS from the 2016 benefits guide. The union is going to contact our state Senator so we'll see what happens.

Best of luck on that.  Our Congress-kitty is none other than Kevin McCarthey.  He'd be of absolutely no help with this.  Instead, I voted with the only voice open to me.  After 15 years of being a BC/BS member I switched to Foreign Services Benefits Plan.  Oh, BTW might want to add GEHA to that complaint as well.  We had a health fair today, and there were only two health care providers in attendance, BC/BS and GEHA.  Both explicitly exclude transgender sex change surgeries.  If you get any movement, let me know.
Thanks,

-Alana

[jenifer356]

will be watching this thread and hoping for good news as I am BCBS/FEP as well

jenifer

[SarahJ]

Has anyone heard anything about whether BCBS is going to add the coverage?  I've been with them for like 20 years and haven't had any complaints about coverage until now.   

Sarah

[Wynternight]

Has anyone heard anything about whether BCBS is going to add the coverage?  I've been with them for like 20 years and haven't had any complaints about coverage until now.   

Sarah

As of 2016 only hormones are covered. Surgery is still excluded in violation of the OPM directive.

[Kara.A.I]

I'm hoping the (possible) new health care directive helps everyone!


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[michelle]

Hi, I have Medicare Wellcare of Florida (HMO).   The plan used to say it denied transition health services, hormones, and SRA.  For 2016, the plan just does not mention it.   I am not sure now rather it covers anything or not and what it does cover.   There still very few Wellcare mental health care professionals who can prescribe hormones for me.  I have to use public transportation to get around.   Reply if you know anything about this coverage for those of us on Medicare plans.

[Cakemonstomus]

That's amazing news! (Especially for a woman who works at a public library)