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Employee Health Benefits

Click here for more info on trans health benefits covered by employee insurers
[Updated August 15, 2007]

As of July 1, 2005, UC’s employee insurers (with the exception of Western Health Advantage, which insures relatively few UC employees) began offering coverage of certain transgender-related surgical needs. While print materials regarding the coverage are not yet available, UC employees and their covered family members should feel free to call their insurer’s member services department with questions about the coverage, since the insurers indicate they have trained their customer services staff in this regard. Should they have additional questions, employees are encouraged to call the UCOP staff member who helped negotiate the coverage: Joan Manning, 510-987-0746. UC health insurers for employees also offer hormone therapy and psychological counseling.

National List of Campuses Providing Hormones and SRS [for employees]:
[updated January 2013 by the Consortium]

  • American University - one health plan option includes coverage, another option does not
  • Harvard University
  • MIT ­ hormones only
  • Northwestern University
  • Penn State University ­ hormones only
  • Syracuse University
  • University of California 10 campuses
  • University of Michigan
  • University of Pennsylvania
  • University of Vermont
  • Yale University ­ faculty and exempt (non-union) staff; union negotiations continue

Student Health Insurance - As of 2011, all UC campuses use the same Student Health Insurance Program that includes both hormones and SRS. The insurance provider is Anthem BC.

Click here for a Comparison Chart of all UC Campuses (PDF) [updated May 2009]

Click here for a Packet of Trans Health Resources (PDF) [updated May 2009]

Click here for an example of one GSHIP committee's negotiations (PDF)
This PowerPoint illustrates the kinds of decisions committees face when examining coverage and cost options.

Click here for the San Francisco City and County Transgender Health Benefit (PDF)
This document includes Actuarial Information showing the low fiscal impact of trans health benefits inclusion.

Click here for the American Medical Association Resolution on "Removing Financial Barriers to Care for Transgender Patients" (PDF)

Click here for the "WPATH Clarification on Medical Necessity of Treatment, Sex Reassignment, and Insurance Coverage in the U.S.A." (PDF)

UC System Information - As of 2011, all UC campuses use the same Student Health Insurance Program that includes both hormones and SRS. The insurance provider is Anthem BC.

Student health insurance plans are dealt with campus-by-campus. USHIP and GSHIP are undergraduate and graduate student insurance plans respectively. Each UC campus negotiates these insurance plans on a sometimes annual basis, with a campus health advisory committee. Sometimes multiple campuses negotiate together.

What student transgender health coverage is provided by other UC campuses?

UC Santa Barbara – since 2005-06 (SRS & Hormones)

  1. $300 deductible, and 80% is covered if the student stays in network (use a preferred provider).
  2. 50% is covered if students go out of network. There are no preferred providers in the network that perform sexual reassignment surgeries.

UC Irvine – since 2007-08 (SRS & Hormones) - USHIP only

  1. 80% is covered if the student stays in network (use a preferred provider).
  2. 60% is covered if students go out of network.
  3. Coverage goes to 100% after $3000 is paid out pocket by the client.

UC San Diego – since 2007-08 (SRS & Hormones)

  1. As of 2007-2008, UC San Diego USHIP and GSHIP programs cover Trans health benefits up to $25,000 per year. Information is online at: http://studenthealth.ucsd.edu/shipabout.shtml
  2. Undergraduate Students: $283/quarter or $849/year
  3. Graduate and Professional Students: $498/quarter or $1494/year
  4. Underwritten by: National Union Fire, Insurance Company of Pittsburgh, Pa.

UC San Francisco since 2008-09 (SRS & Hormones)

The insurance policy covering 2,000 or so graduate students at UC San Francisco (which has no undergrads) was changed for 2008-09 to provide coverage for sex reassignment surgeries, with an annual cap per student of $10,000. The coverage resulted in a very modest premium increase, which was approved by the advisory committees involved. For more info, contact Shane Snowdon, UCSF LGBT Resources Director, shane.snowdon@ucsf.edu.

UC Santa Cruz – since 2008-09 (SRS & Hormones)

The insurance policy for both undergraduate students and graduate students was changed for 2008-09 to provide coverage for hormones and sex reassignment surgeries, with a maximum cap per student of $75,000.

UC Berkeley, UC Davis, UCLA, UC Riverside – since 2009-10 (SRS & Hormones)
All three campusesbegan covering homones and SRS in 2009-10.

UC Merced - since 2010-11 (SRS & Hormones) - GSHIP only
UC Merced joined the UC system-wide GSHIP program (with Davis, SF, San Diego, Santa Cruz, and Hastngs College of Law), which is Trans-inclusive.

What medical coverage might be needed by transgender students?

  1. Hormone therapy (e.g. testosterone or estrogen) consultation, prescription, and maintenance provided by physicians familiar with/expert in transgender health concerns
  2. Sex reassignment surgery (SRS) which may include various surgical procedures that can foster congruence between physical body and gender identity

What is the impact on students who are unable to access transgender health care?

  1. Students’ academic performance may suffer as they devote time, energy, and money toward their health care needs rather than other concerns.
  2. Students may struggle with mental health problems that result from being unable to access appropriate and necessary medical care. This denial of health benefits also contributes to a climate of stigmatization and discrimination of transgender people, which can result in depression, anxiety, potential suicidality, and other impediments to good mental health
  3. Students order hormones online, or find other unsafe and unmonitored sources for obtaining hormones, which may be dangerous. They self-administer hormones rather than be under the expert care of a physician.
  4. Students unable to pursue SRS risk long-term negative safety consequences.
  5. Students are unable to travel to conferences or seminars which are necessary for their professional development as a graduate student and future academic, nor are they able to properly represent the University at these events, because, without SRS, students are unable to change the gender on their birth certificate and thus acquire identification meeting the REAL ID Act standards.
  6. Students risk the development or worsening of existing medical problems due to fear of discrimination by medical professionals or lack of access to medical care.

National Information

National List of Campuses Providing Hormones and SRS [for students]:
[updated October 2012 by the Consortium]

  • Emerson College
  • Emory University
  • Harvard University [top surgeries only - mastectomy and breast augmentation]
  • New York University
  • Northwestern University
  • Portland State University
  • Stanford University
  • University of California, Berkeley
  • University of California, Davis
  • University of California, Irvine [undergrads only]
  • University of California, Los Angeles
  • University of California, Merced [graduates only]
  • University of California, Riverside
  • University of California, San Diego
  • University of California, San Francisco
  • University of California, Santa Barnara
  • University of California, Santa Cruz
  • University of Michigan
  • University of Washington

National List of Campuses Providing SRS only [for students]:
[updated August 2009 by the Consortium]

  • Washington University in St. Louis

National List of Campuses Providing Hormones only [for students]:
[updated March 2010 by the Consortium]

  • American University
  • Bridgewater State College
  • Cornell University
  • Emory University
  • Massachusetts Institution of Technology
  • Ohio State University
  • Pennsylvania State University
  • Princeton University
  • Suffolk University
  • University of Vermont
  • University of Wisconsin, Madison

Washington University in St. Louis has coverage for SRS, but not hormones [2009]:

http://www.aetnastudenthealth.com/schools/washu/brochure0910.pdf

Transgender Identity Dysphoria Expenses

Transgender Identity Dysphoria is a Covered Medical Expense when it is administered for
the following indications by a health care provider, who is a legally qualified physician or
psychiatrist who is practicing within the scope of their license.

Benefits as payable as any other surgical condition after the insured individual has satisfied
a waiting period of twelve months of continuous coverage under the Washington
University in St. Louis Student Health Insurance Plan before becoming eligible for
transgender surgical benefits.

Benefits are not payable for any expenses which relate to the following (this is not a
complete list):
• Transgender hormone drug therapy;
• Cosmetic surgical procedures;
• Laser hair removal;
• Silicone implants.

A referral from Student Health Services is required.

Partial hospitalization, inpatient, and outpatient benefits for Transgender Identity Dysphoria
require pre-certification.

Transgender Identity Dysphoria Expense benefits are payable as follows:
Preferred Care: 80% of the Negotiated Charge.
Non-Preferred Care: 50% of the Reasonable Charge.
Benefits are limited to a $25,000 per lifetime maximum.

University of Washington has coverage on its student insurance only [2008].

http://depts.washington.edu/ovpsl/2008-09%20Booklet.pdf

The list of what is and isn't covered:

Hysterectomy? No
Mastectomy? No
Chest reconstruction? No
Breast reduction? No
Facial Feminization? No
Tracheal shaves? No
Phalloplasty? Yes
Metaoidioplasty? Yes
Vaginoplasty? Yes
Labiaplasty? Yes
Electrolysis/laser hair removal?No
Travel Costs? No
Lodging expenses? No

The University of Michigan Information [2007]:

At the University of Michigan, some trans health services including some surgeries are offered under student and employee plans. All of these plans will cover genital surgery, hysterectomy, HRT, mental health therapy, for patients who meet criteria under either the BCBSM/BCN internal guidelines or the Aetna guidelines (for the Chickering plan). Both student plans will also cover top surgery for FTM. Recently the BCBSM/BCN plans would not cover top surgery, but the status of this is not clear at this point in time. In addition, the BCBSM/BCN plans are structured to make it difficult to utilized providers who are not "in-network", and all plans reimburse in-network providers better than out-of-network ones.

UM Students:

  • Chickering/Aetna student plan (as of September 2007) available to all students. (Up to $25,000 lifetime max coverage for GID diagnosis related expenses)
  • GradCare (BCN Blue Care Network HMO Product) available to graduate student employees, as well as certain other graduate students under fellowship.
    (Both of these students plans will cover FTM top surgery.)

UM Employees:

  • UM Premier Care (BCN Blue Care Network HMO Product)
  • BCBS Michigan Community Blue PPO