INSURANCE NAVIGATION FOR TRANSGENDER, NON-CONFORMING, AND INTERSEX PEOPLE

TGI healthcare is considered a right in the state of California. There are several legal interpretations, regulations, and assembly bills that protect the rights of TGI people. State-regulated insurance through management plans like Medi-Cal or Covered California are encouraged; as they have contractual obligations with the State of California to include TGI-affirming healthcare coverage.

What is the best healthcare insurance for TGI people?

When relying on the best healthcare insurance for TGI people, it is best to not rely on the name of the insurance to assume proper coverage. The name of the insurance is the generalized name; however it does not ensure effective coverage for TGI needs.

Blue Cross, Blue Cross Commercial, Blue Cross Federal have can be confusing:

Some insurances -like Blue Cross- have different plans that make things complicated. For example, there is Blue Cross Commercial and Blue Cross Federal. The former, through Covered California, may cover more areas of hair removal; whereas the latter generally only covers Blue Cross Federal generally only covers confirmation surgery preparation. The management plan for Medi-Cal, called Inland Empire Health Plan (IEHP) covers confirmation surgery preparation. Other areas are called “quadrants”: the face, neck, chest, back, and abdomen. As it pertains to hair removal, these quadrants are considered common under the World Professional Association for Transgender Health (WPATH) Standards of Care for TGI people.

Compared to IEHP, another Medi-Cal management plan, California Health and Wellness (CHAW) requires only six months living as the gender the member identifies as; whereas IEHP’s requirement is a full year.

The employed often have different plans:

When an employee, there are two different insurance plans that determine if California has the authority to enforce TGI healthcare (or if it can be an elective within the plan). Your human resources department can clarify the contractual agreement of the business with the insurance company in the event you seek reimbursement for procedures. To simplify this process, plans that are self-paying (or that an employee pays into) are federally regulated.

Tribal nations and tribal businesses

Tribal nations and businesses that hire non-tribal employees may or may not provide trans-affirming coverage. This depends on the belief system of the tribe’s decision-makers. Federally-regulated TGI-affirming healthcare is typically not as supportive as California-regulated insurance plans. Medicare is not as affirming as Medi-Cal. California has very specific state requirements that prohibit healthcare discrimination.

Being denied insurance coverage what to do?

It is very common for trans-affirming coverage to be denied; as it is often deemed cosmetic or not medically necessary. These preclusions will be in your employee insurance book (which employees usually have access to online). To reduce fatigue and mental exhaustion, an electronic version of your insurance coverage can be searched by using Control F on the keyboard. This should pull up the “Find” box, which allows you to search your plan for keywords (like transgender, cosmetic, hormone, etc.)

If you must contact an attorney with your employer

We hope that the above guidelines help, so that you can maximize your TGI-affirming healthcare and your quality of life. It is best to contact an attorney for legal advice. However, before sharing with your employer that you contacted an attorney, you should first attempt to work with your HR department and explain how their healthcare limitations are affecting you. There is often provisional language that allows a business to amend its plan or to provide certain exceptions in order to accommodate you. The Transgender Health and Wellness Center is open to meeting with your HR department to help guide them in providing TGI-affirming healthcare coverage to you. We do this by sharing best practices and coverage models.