On Tuesday of this last week I attended a group onboarding session with my new employer where we were directed to a specific member of the HR Team for answers to any questions we might have about health insurance coverage. I contacted this person via email that evening regarding a few cost clarifications.
I also spoke on the phone with the insurance company's Customer Service on Wednesday to see if I could get information about transgender care, which led to the subsequent email chain I've had with my HR Rep so far, copied below.
As you'll see, it's been a little frustrating.
My emails are in purple.
My HR Rep's emails are in red.
Redactions and comments are within [brackets] in black.
Wednesday 02/20/2019
Hello [HR Rep's Name],
Thank you for your reply and follow up.
Do you have a current pdf of the [Name of Insurance Company & Plan] benefit reference manual that you could email to me please? I have some questions about covered health services and policies unique to my situation, and I'd like to get some more information prior to making my health insurance enrollment selection. I tried reaching out to [Name of Insurance Company] Member Services, but since I'm not yet enrolled, they could only give me very general information and I also can't yet view a copy of the benefit reference manual online.
Thank you very much!
[My Current Name]
Wednesday 02/20/2019
Hi [My Current Name],
Of course I do!
I have attached:
• The Summary of Benefits and Coverage (SBC) for all 3 of the [Name of Insurance Company] plans
• The [Name of Insurance Company] Enrollment Quick Kit
I forgot about & think I now need to send this to new employees.
Let me know if you find it helpful, and I'll start sending it out.
• The 2019 Benefit Guide
I wasn't sure if you had this or not; It covers pretty much everything that was in the presentation [on Tuesday].
Hopefully, this will help you make your decision. If I can be of further help, please feel free to contact me.
Thanks!
[HR Rep's Name]
Wednesday 02/20/2019
Hi [HR Rep's Name],
Between [Onboarding Rep's Name] and the Onboarding Team, I did receive all of these previously, but it's great to have them all in one place in my inbox; thank you!
Actually, what I was requesting was a copy of the full benefits reference manual, which will in all likelihood be several hundred pages, and which I don't yet have access to since I'm not yet a member. I have some specific health concerns, and I need to know what specific care is and is not covered under the [Name of Employer] plans. With a quick search of the benefits manual pdf – if I can see it – I'll be able to answer all of the questions I have on my own.
If there are different benefits reference manuals for each of the [Name of Employer] plans, then I'd be most interested in the one for the [Highest Premium / Lowest Out Of Pocket Max] plan, although the coverage inclusions/exclusions should be the same for all cost and coverage levels, albeit with different copays, deductibles, and out of pocket costs.
Again, thank you very much for the kindness of your time [HR Rep's Name]!
[My Current Name]
Thursday 02/21/2019
Hi [My Current Name],
I am glad you asked because I don't have them and I should. I have asked our contact for them.
As soon as I get them, I'll forward them on to you.
Thanks!
[HR Rep's Name]
Thursday 02/21/2019
Hi [My Current Name],
Here are the 3 booklets I believe you are looking for.
Thanks!
[HR Rep's Name]
Friday 02/22/2019
***For this message, I'd very much appreciate it if you'd ONLY reply to me at this email address please. [The HR Rep and I had been previously copying the Onboarding Rep and my work email address.]
Hi [HR Rep's Name],
Again, thank you very much for your time. Your kind assistance is truly appreciated; these are exactly what I was looking for!
Unfortunately, the coverage information I was hoping to find is not included in any of the three [Name of Insurance Company] benefits manuals you sent. I searched all three with the same terms and found that the partial non-relevant matches are identical and in the same place on each page in each of the three manuals. So without reading all three side by side from cover to cover, it's probably reasonable to assume that the language about included and excluded care coverage is the same for all three plans (again, albeit with different copays, deductibles, and out of pocket maximums), which was what I expected and would seem reasonable.
Either the care I was hoping to confirm coverage for is not covered, or a description of the relevant coverage is not included in the manual(s) due to the relative rarity of my health needs. I'm hoping that the latter is the case.
Because this is [Name of Employer] and because I suspect that there are other [Name of Employer] Team Members who are in a similar situation, I'm going to trust you and share with you my particular health concerns in the hope that you might be able to follow up with [Name of Insurance Company] and advise me on what my [Name of Employer] coverage for these would be please.
I am transgendered, and want to begin the process of MTF full time social transition this summer once I have completed my [Name of Employer] training and have settled into my new position. Currently you are the only person at [Name of Employer] with whom I have shared this information, although I of course intend to share this with [Name of My Work Group] Leadership and my colleagues prior to beginning my social gender transition once I have completed my 90 day evaluations.
At this point in my transition process and for the remainder of 2019, I anticipate that my care will involve limited psychotherapy, mainly for general process orientation, resource reference, and to satisfy any Prior Authorization requirements, but will mostly involve gender confirmation hormone therapy requiring medical office visits, lab tests, and especially prescriptions.
Again, thank you very much for the kindness of your time, and for whatever assistance you might be able to offer [HR Rep's Name]!
With Warmest Regards,
[My Current Name]
Friday 02/22/2019
Hi [My Current Name],
I won't say a word!
From my past experiences with the [Name of Insurance Company] insurance booklets, I am rather confident that all 3 booklets are pretty much the same on what they cover.
I can check to see if there is something specific you are looking for that is not stated directly in the booklets.
Thanks!
[HR Rep's Name]
Friday 02/22/2019
Hi [HR Rep's Name],
> On Fri, Feb 22, 2019 [HR Rep's Name] wrote:
> Hi [My Current Name],
> I won't say a word!
Thank you for keeping my confidence about this. It's not that I'm concerned about having my transgendered status known at [Name of Employer], because I'm not concerned about this.
My concern right now is that I want to be the one to tell my Leadership in a few months when the time is right, and to not have them find out about it before I'm ready to tell them myself.
However, if you need to refer my questions to someone else in [Name of Employer] HR, you absolutely have my permission to do so. They can take over and follow up directly with me at this email address if need be.
> From my past experiences with the [Name of Insurance Company] insurance booklets, I am rather confident that all 3 booklets are pretty much the same on what they cover.
Understood and agreed.
> I can check to see if there is something specific you are looking for that is not stated directly in the booklets.
Thank you very much. Here are my specific questions [which my HR Rep apparently missed in my previous email; now restated in a bold numbered list for maximum clarity]:
1) In general, does [Name of Employer] health insurance cover gender transition health care? If so...
2) Would gender transition psychotherapy be covered?
3) Would office visits to be evaluated for and prescribed gender transition hormones be covered?
4) Would the lab tests required to be prescribed gender transition hormones be covered?
5) Would prescriptions for gender transition hormones be covered?
Note that the [Name of Insurance Company] benefits manuals return no search results for "gender," "trans," or "sex" even remotely related to care for a transgendered individual seeking transition and gender confirmation, which is frankly incredibly disappointing. [!!!!!]
I also have one additional question:
6) Apart from [Name of Employer] health insurance, are there any alternative funding resources available at [Name of Employer] to assist a transgendered employee undergoing transition? [The organization I work for is extremely open and specific about supporting LGBTQ+ rights.]
Again, thank you very much for the kindness of your time [HR Rep's Name].
I look forward to hearing from you, or from whoever in [Name of Employer] HR might be appropriate with the answers to my questions.
With Warmest Regards,
[My Current Name]
I'll update this thread with what I find out.
