Trans Federal employees are likely far too familiar with the fact that the Federal Employee Health Benefits Program (FEHB/FEHBP), like an ever-shrinking number of private health insurance providers, refuses to cover any and all procedures related to gender transition. Despite dozens of plans to choose from, every plan (with the exception of one regional plan in California) contains largely identical verbiage prohibiting coverage of anything related to "sex transformations." I've done quite a bit of homework on the trans exclusions, and I've found some things that I think every trans Federal employee should know.

That the exclusion is worded nearly identical in every plan is no coincidence: the exclusion is included in a base set of exclusions the Office of Personnel Management (OPM, the agency responsible for the FEHBP) gives to all its contracted insurers, to which they can add to as they please. (Interestingly, OPM's exclusion dates back to 1974, years before Janice Raymond's horrible 1981 paper prompted most private insurers and Medicare to add theirs.) I think it's significant that the exclusion originates with OPM, rather than with the insurers; that means OPM has arbitrarily decreed that Feds with gender dysphoria can't get the treatment they need, unlike every other malady, which is blatantly discriminatory.

Only a single FEHB provider—Kaiser Permanente in Northern California—has requested permission from OPM to remove the exclusion and had that permission granted. (It's unclear whether any others have requested permission and been denied.) Unfortunately, this isn't because of California's laws prohibiting healthcare discrimination against trans folks: FEHB is exempt from all state and local healthcare laws. (Thus residents of Colorado, D.C., Connecticut, and the rest of California are still out of luck, unless you forego FEHB altogether and buy an expensive individual-market plan.) It's unclear whether any others will follow suit, unfortunately. OPM is extremely secretive about this issue; if you call and ask them about this, you'll immediately be referred to their General Counsel, in my opinion a sure sign that they know this is illegal discrimination and have no choice but to lawyer up. There have been whispers that they're considering it for 2015, but the yearly Call Letter just released outlining changes for 2015 doesn't mention it anywhere.

What can you do, as a trans Federal employee?

• If you're a Federal employee in transition, try to file claims for HRT/SRS/mastectomy^* with your current FEHB provider. If they get denied, immediately file an EEO complaint against OPM. Their EEO office line is 202-606-2460.
• Talk to HR at your individual agency about the exclusion, and let them know how much of a hardship it causes. (I think it could be framed as a serious retention issue when it comes to STEM employees, due to the surprising preponderance of trans women in tech; it's telling that tech firms like Google, Apple and Microsoft were some of the leaders in removing their own exclusions.) Ask if they can go on record with OPM as wanting the exclusion removed.
• Call your current FEHB provider and request that they work with OPM to remove the exclusion for their own plan(s). If they're courageous enough to do so, maybe they can be the next to follow in Kaiser NorCal's footsteps. (Unfortunately, mine wasn't.)
• Call OPM's Healthcare and Insurance office at 202-606-1234 and tell them you need the exclusion removed.
• Write letters to John O'Brien (Director, Healthcare & Insurance), the man with the direct authority to remove the exclusion (whose inaction is currently responsible for it remaining in place), and to his boss, Katherine Archuleta (Director, OPM), about the same. Both are located at 1900 E Street NW, Washington, DC 20415.

If enough of us put pressure on OPM through every possible avenue, I'm confident the exclusion will eventually be removed. Trans Feds, let's work together and get this done. 

^{* I'd avoid filing claims for more cosmetic procedures like FFS, breast augmentation, tracheal shaves, and hair removal. Kaiser NorCal, the one FEHB provider that's removed the exclusion, only covers HRT, SRS and mastectomy, and when OPM inevitably does remove the exclusion someday, I see these being the only things they'll cover. (I personally feel that's fair, as there are plenty of cis women out there that have small breasts, facial hair, and/or masculine features and have to pay out of pocket to deal with them.)}

Thank you for the information. If I am turned down I plan to fight it based on discrimination as high up as possible. They know they are in the wrong on this.

I was at a place that was self insured and that cut every single transition need I have out from their plan as neatly as you've described the feds do. I went to HR and they didn't care so I ended up with private insurance. I hope you have better luck but I will admit, I found owning my own health insurance quite comforting and once I get back on my feet I may return to it.

Still, the discrimination sucks and it's wrong and I'm sure makes work very uncomfortable.

The only other caution I feel I should put out is I left that employer where my co-workers were talented professionals but the benefits sucked to go somewhere where the benefits were great but my co-workers were... helpless. Had the job order been switched, I'd be happy to be at the employer that discriminated against me health wise. Still would probably dig at em' but I do recommend considering your approach with great care if you like your job.

I'd say that it's too late to fight to get my top surgery covered. It was almost five years ago.

Quote from: Misato on March 30, 2014, 10:49:39 PM
I was at a place that was self insured and that cut every single transition need I have out from their plan as neatly as you've described the feds do. I went to HR and they didn't care so I ended up with private insurance. I hope you have better luck but I will admit, I found owning my own health insurance quite comforting and once I get back on my feet I may return to it.

Private health insurance isn't a realistic option for many Feds, unfortunately. Federal jobs are notoriously uncompetitive in pay, but made up for by good benefits like FEHB; requiring trans Feds to double or triple what they pay in healthcare costs is ludicrous when living in D.C. as anything under GS-12 is hard enough as is. I suppose one could temporarily switch to a private plan for a year, get the surgeries one needs, then switch back to FEHB afterwards, but I haven't done the math to see if that would offer any significant cost savings over paying for the procedures out-of-pocket. (HRT, on the other hand, is almost certainly cheaper to keep FEHB and pay out-of-pocket for.)

Incidentally, now that Congress and their staffers are no longer on FEHB but instead receive credit towards plans on the (trans-inclusive per District law) D.C. exchange, they now have trans-inclusive coverage, while normal Feds don't. Good news for any closeted trans Congressmen out there.

Hi everyone,

The message that begins this thread is a very good summary of the current FEHB situation and a good outline of steps that can be taken.  To this I will add that GLIFAA (LGBT+ EAG for State, USAID, and other foreign affairs agencies) teamed with FedQ late last year to submit a detailed white paper to OPM asking for removal of the "transgender exclusion."  There has been no response.  That's the bad news.

On a more optimistic note, our Undersecretary for Management has put the Department of State on record with OPM as asking for elimination of the exclusion.  I expect that USAID will also do so shortly.  If anyone on this list is able to get their own federal department or agency to do the same, it can only help.

Finally, GLIFAA is lobbying the one FEHB plan that caters specifically to the foreign affairs community.  That's the Foreign Service Benefit Plan that is administered by the American Foreign Service Protective Association.  If we can not get through the front door at OPM, we feel we have a stronger hand with the one provider that ostensibly exists for us.

For more general information on GLIFAA, see www.glifaa.org and our Trans* Resource page at www.glifaa.org/resources/trans-resources/.  If you are interested in more detail on the actions that GLIFAA is taking regarding the effort to remove the "transgender exclusion," write to me at president@glifaa.org.

Fighting to remove the exclusion,
Robyn

Quote from: บ้านสิริรอดชีวิต on March 30, 2014, 10:30:40 PM
^{* I'd avoid filing claims for more cosmetic procedures like FFS, breast augmentation, tracheal shaves, and hair removal. Kaiser NorCal, the one FEHB provider that's removed the exclusion, only covers HRT, SRS and mastectomy, and when OPM inevitably does remove the exclusion someday, I see these being the only things they'll cover. (I personally feel that's fair, as there are plenty of cis women out there that have small breasts, facial hair, and/or masculine features and have to pay out of pocket to deal with them.)}

I did confirm over the phone with Kaiser, that the SoCal FEHB plan coverage is the same as NorCal.  I spoke with the nurse that makes referrals for transition patients and she wasn't certain that was true for Federal employees, but confirmed with their plan managers that it was.

Freya