Individual Health Insurance Plan Info

[Ms Jessica]

So, the bad news: my wife lost her job.  The worse news (in a selfish kind of way): we lost our health insurance. 

My job offers insurance through United Health/Pacificare, and they don't cover trans-anything.  I had our HR check, and I think they just won't cover it.  I don't believe it's specific to our company, I think it's a policy of the insurance company. 

We have Aetna (or will for another few hours anyway).  Aetna has covered all of my therapy visits, my endo, blood work, prescriptions for HRT, the whole nine yards.  I've been so happy with it, we called to see if they had any individual plans that cover trans-anything.  The answer is no.  Their underwriting policy has transgender exclusions built into it. 

The Aetna rep we spoke to gave us a number for the state of CA health insurance something or other that we'll be calling tomorrow.  From what I understand, you explain what you want coverage for, they search their database and tell you if anyone covers it.  I'll post the number later if I remember and/or anyone is interested. 
--Edit--
Here's the number:
1-800-925-4357
Please note this is for state of California only.
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In the process of searching online, I found this.  I hope the link is okay with both the host and admin here.  If not, please edit as appropriate.  Anyway, the interesting thing is that there are several companies, including Kaiser, Blue Shield, Health Net and Cigna that all cover trans-related treatments, about the only thing not covered by some of these plans is FFS.  A quick note, though.  All of the plans discussed would be purchased through an employer, and do not contain info for individual/family plans. 

Also, HRC releases the corporate equality index every year.  Here is the one for 2009.  One of the appendices has healthcare related info, including which employers offer coverage for transition related treatment.  It's not very specific, but it's a start. 



I'm hoping that anyone with good health insurance can post who their carrier is and what (if anything they cover).  Please also include whether your insurance is through your job or if it's an individual plan.  Don't feel pressured to reveal where you work unless you care to release that info.  A state of residence might also be helpful so that people know what might be available to them.  I checked the wiki and reference pages, and as far as I can tell, I'm not duplicating information that exists elsewhere. 

The goal is to locate different trans-friendly insurance carriers, and whether they'll cover things like therapy visits or HRT. 

So for me,

We had Aetna
obtained through Wachovia Bank (wife's employer)
Premium was about $400/month for two people (our out of pocket)
Coverage included therapy, HRT prescriptions, Endo visits, blood work
I believe SRS is also covered through the plan that we had. 

We've previously had
Pacificare HMO
obtained through my work (which I won't disclose)
Premium was about $120 or $130 per month for two people
Coverage included mental health benefits for serious mental illness only, such as depression
GID, gender transition, etc. were all specifically excluded from the policy. 

[placeholdername]

Where would I look in the plan to see if GID stuff was covered?  Health Insurance is not one of my expert knowledge zones .

[Ms Jessica]

You should have gotten a booklet with terms of coverage, limitations, and exclusions, probably with whatever forms you filled out when you enrolled.  I don't think there's a specific place to look, but if there's a specific set of exclusions listed, you're looking for language such as

The following are not Covered Benefits except as described in the
Covered Benefits section of this EOC or by a rider attached to the EOC: Transsexual Surgery, sex change or transformation, including any procedure or treatment or related service designed to alter a members physical characteristics from the Member's biologically determined sex to those of another sex, regardless of any diagnosis of gender role or psychosexual orientation problems.

It can be a daunting task to find one such paragraph in those booklets because not all, IME, have one single section for exclusions.  They can be scattered all over the place. 

Also, for anyone in danger of losing their job (or if you recently did) here's some info on COBRA
And here's the FAQ for the premium reduction that was part of the American Recovery and Reinvestment Act of 2009.  It's a great deal if you need to continue your insurance and are worried about having the money to pay for it.  It only gets you your same insurance that you had before, but it's better than nothing.  There are some restrictions on the premium reduction, so it pays to look at the FAQ. 

We won't qualify (my wife and I) because we're eligible for coverage under my employer's health insurance.  Still, I thought someone here might find this useful, so I'm passing it on. 

[Janet_Girl]

Kaiser sucks.  The only thing they will cover is HRT.  No therapy, no surgeries ( even though they cover Orchidectomy, but only for medical necessity. i.e. Testicular cancer ).  They will cover SRS if the State of Oregon adopts the AMA resolution 122.

I wish there was an insurance that covers SRS.  We have BCBS at work, but I don't know if they cover it or not.  And if they did they would say I am pre-existing condition.

Janet

[Ms Jessica]

I've heard bad things about Kaiser, too.  I find it odd that they don't cover therapy, even the Pacificare coverage available through my employer will cover 20 visits per year (serious mental illness only, so I've got to break out the depression again).     Of course, I don't get my HRT covered anymore.  I think HRT is more expensive, at least when you're only seeing the therapist once a month. 

I think you might be having bad luck with Kaiser because of the company you work for, though.  I'm not an expert in this kind of thing, either, but it seems like a lot of corporations are able to control the terms of their insurance coverage-- in other words Wachovia or Wells Fargo banks can cover SRS on (a nearly) identical Aetna plan that Starbucks offers.  Except Starbucks might not cover SRS.  It all depends on whether the employer asks for certain types of coverage to be included. 

I'm not actually sure what can be done about that, though.  I've heard the same thing from a lot of people-- the insurance company covers what the employer wants them to, but I've never heard of instances where the drive to improve insurance coverage comes from the people on the bottom.  Has anyone else? 

I'm not holding my breath for my own insurance.  I work for a small company, and the only person who would benefit from any inclusions of SRS, etc would be me.  If there was a premium hike that went with it, I'd probably be lynched.