Hi,
I think folks didn't find this where I initially posted it, but it is important so I'll repost it here..
We Are Winning!! :D
I got a message from my lawyer, and for trans folks in the US this is very big news: The federal office of personnel management has removed the mandatory exclusion for Gender Confirmation Surgery (SRS) from the federal guidelines. What this means is that on the next open enrollment period for federal employees, plans may offer GCS as a covered benefit. Some will!
Private insurers will likely soon follow suit in most states.
Here is the official announcement.
On June 13, the Office of Personnel Management (OPM) quietly released a
"program carrier document" related to the Federal Employee Health Benefits
Program (FEHB). The subject of the letter is "Gender Identity Disorder/Gender
Dysphoria."
The effect of the letter is to allow federal employee health insurance carriers to
provide insurance for sex change operations and for expenses related to a sex
change operation. OPM describes this as the need to provide health benefits
consistent with each person's individual medical status before and after gender
transition. The OPM letter also states that OPM is removing the requirement that
FEHB brochures exclude "services, drugs, or supplies related to sex
transformations."
According to the OPM letter, health insurance carriers cannot remain silent on
the issue. Instead, carriers will have to propose one of two options:
Remove the General Exclusion language and provide to OPM the specific
brochure text that describes the covered components and limitations of care for
the diagnosis; or Maintain the General Exclusion language for the 2015 plan year.
The federal government's Medicare program also lifted a ban on sex reassignment
surgeries about two weeks ago.
And here is the link to the Carrier Letter
http://www.scribd.com/doc/229774316/FEHB-Letter-2014-17
:eusa_clap: :eusa_dance: :icon_caffine: :icon_joy: :icon_geekdance: :icon_rockon: :icon_dance: :icon_pelvic_thrust2: :icon_yes: :icon_woowoo:
Pretty cool huh!
What Jessica said. :icon_mrgreen:
I'm so happy to hear that for you congratulations! I just got good news for myself. About a week after I heard about Medicare dropping it's ban I was informed that I was being switched from my current coverage under Masshealth to Medicare. I don't enroll in it till September but once on it I plan to petition for GCS. My current plan is to have it next summer in between school semesters.
Hell yes!!!
A definite HELL YES!! and a few othe choice happy expressions come to mind as well! YaY!! :eusa_dance: :eusa_clap: :icon_dance: :icon_geekdance: :icon_evil_laugh: :icon_dribble: :icon_doh: :icon_censored: :icon_censored: :icon_yes:
Ally :icon_flower:
That's excelent on that level. I can personally attest that when I started my job six years ago there were exclusions in place. POOF the exclusions on TS treatment disappeared a few years later, without any notice whatsoever. I have had every treatment I have claimed paid for, including SRS recently. I find that pretty astounding and welcome for my conservative area near STL.
OMFG this might mean that I can get my SRS covered by the time I'm ready for it
We really are winning, gals! This is a time to celebrate! AMERICA, Y'ALL!
Yes we are winning. This applies to the guys too!
j
Thanks for that, Julie... ;)
All I can say is it's about time!! YaY!
Ally :icon_flower:
To make sure I'm reading this correctly, basically in the US that means srs cannot be excluded by insurance providers anymore, right?
thanks for info
Not quite. For US federal employees there was a mandatory exclusion for gender related surgery insurance coverage. That exclusion has been dropped. The implication is that the market will provide such coverage the next "open enrollment" period for 2015. Further, the exclusion was also dropped from Medicare coverage three weeks ago, and coverage inclusion will be on a case by case basis.
States can still block Medicaid clients, and private insurers have provided SRS surgery coverage for some time.
The real importance of this is a sea change in attitude and acceptance. With coverage in the Federal public sector, other barriers will fall. It doesn't guarantee anything for many trans men and women, but it makes fair insurance coverage possible and much more likely.
j
It's a step forward, to be sure. But there's still a lot of us that are under the thumb of private insurance companies (like mine it turns out) who still refuse coverage, and not just for GRS. Mine also refuses to cover any medication, or therapy that's associated with being trans. Yay. :/
I'm SO happy for you :-) . Nice to see such a change in the US! I hope it nicely progresses for ALL of you there :-) .
In Czech Republic sex reassignment therapy medical expenses are mostly fully covered by the medical insurance system since like end of 40s (few years after first SRS was performed here) as it's considered a serious medical state. That includes consultations, hormones and SRS.
So it always made me a bit sad that the same medical issue is treated so differently when it comes to medical insurance.
Quote from: Shodan on June 25, 2014, 11:27:30 AM
It's a step forward, to be sure. But there's still a lot of us that are under the thumb of private insurance companies (like mine it turns out) who still refuse coverage, and not just for GRS. Mine also refuses to cover any medication, or therapy that's associated with being trans. Yay. :/
Is that company coverage? There are lots of plans under the Affordable Health Care Act that do provide these benefits.
j
Quote from: JulieBlair on June 25, 2014, 12:00:41 PM
Is that company coverage? There are lots of plans under the Affordable Health Care Act that do provide these benefits.
j
...and not one of them in Wisconsin.
Unfortunately at the moment, states can block coverage options and there is a swath of conservative states that do so capriciously and maliciously. Frankly, I just don't get it. Want to move to Seattle?
Quote from: JulieBlair on June 25, 2014, 12:18:50 PM
Unfortunately at the moment, states can block coverage options and there is a swath of conservative states that do so capriciously and maliciously. Frankly, I just don't get it. Want to move to Seattle?
Yes, actually, or near it anyway. I have a lack of funds for the move. If I ever lose my job, I will sell off everything I own and get there one way or the other.
Quote from: JulieBlair on June 25, 2014, 12:00:41 PM
Is that company coverage? There are lots of plans under the Affordable Health Care Act that do provide these benefits.
j
The ACA plans that are available to me are anything but affordable. Not only do I have to cover myself but I have to cover my family, too and with the income that I'm making that becomes prohibitively expensive. My salary is just enough that these institutions would think that I should be able to cover all my expenses, but not enough to actually do so. :-\ That and Oregon's ACA website is/was so broken that there's no telling what I'd really get anyway.
Quote from: Bijou on June 25, 2014, 11:13:43 AM
To make sure I'm reading this correctly, basically in the US that means srs cannot be excluded by insurance providers anymore, right?
I know my SRS is covered by my insurance. So is my hrt, therapist and Endo visits, and when/if I can find a surgeon, so will my voice surgery. However I'm on disability and have a type of Federal insurance, not state.
However in answer to your question I am not completely sure, but I think that is what this means.
Ally :icon_flower:
More news!
http://transgenderlawcenter.org/archives/10537
Progress: Washington's Health Insurance Policies Cannot Discriminate! 8 states down 42 to go.
The state I live in Florida, though not written into law yet, seems to be following California's model. Our Governor though is being stubborn about signing it into law. My insurance is federal though and follows Washington DC rules, which I believe if I'm not mistaken Washington DC is on the list. In any case my hrt is covered and so is my SRS and so is a trachea shave also my voice surgery if I can ever find a surgeon.
I predict though Florida will be next on the list as we have a pretty large TG community here.
Ally :icon_flower: