Transform Health Project

TransForm Health Project Logo

The Transform health Project has several key goals:

1. To repeal all discriminatory trans health insurance exclusions in Washington State
2. To educating trans people about their legal rights to insurance coverage and healthcare non-discrimination
3. Provide 1-on-1 advocacy and referral services through peer education
4. Educating medical providers through the University of Washington School of Medicine & on site training for community providers.
5. Support community led efforts to locate and list competent providers with partner organizations

Materials on Washington State’s Health Insurance Coverage:

January 2015 – Trans Health Insurance Forum – An Overview of the Policy Landscape
Power Point .pptx file
Video  (No Audio: if you don’t have powerpoint)
PDF File (for printing or easy reading)

MORE INFORMATION ON EACH INSURANCE TYPE:

Private Health Insurance Coverage


Private Health Insurance: (COVERED!)
Our Frequently Asked Questions on Private Health Insurance Coverage
Washington Insurance Commissioner’s Letter to Insurers
Washington Insurance Division’s Website on Trans health insurance coverage
How to file a complaint against your insurer if you are denied coverage

Marketplace Plans (you can purchase plans on Washington Health Plan Finder)
– Regence Blue Shield Policy
– Bridgespan Health Policy
– Group Health Transgender Services Program
– Premera Blue Cross Policies:  Coverage   and Guidelines   (includes coverage for breast augmentation)

State Employees Insurance Coverage

Washington State Employees (COVERED!)
Press Coverage of State Employees Victory
State Employee Plans Website  (all 2015 plans include “Transgender Health Services”, please select your plan book to see the exact coverage)

Self Insured Plan

Self Insured Plans  – These plans are generally larger employers, cities, and counties that fund their own health insurance rather than purchasing from a health insurance company. These plans are governed by a federal law – ERISA (the employment retirement insurance security act) – meaning each plan sets its own policies. We believe there is a strong legal argument that ERISA plans must cover benefits. If you are under a self-insured plan not listed here. We can help you make the case for coverage! Check out our contact page to get in touch.

– Amazon Employees Presentation
– Google Benefits Coverage
–  City of Seattle Benefits:   Council StatementMayors Response;   Benefits Website Documents(2015):  Group Health Standard (most employees); Group Health Deductible Plan ; Aetna Plan (most employees)
–  City of Tacoma Benefits:  City Announcement

Medicare

Medicare (COVERED!)
While Medicare has removed their bar on coverage, there is not yet a specific policy detailing what procedures are covered. Further complicating matters – very few surgeons accept medicare.  We are working with national partners to affect change in new policies (called local coverage determinations) that will detail the benefits and requirements of coverage. People on Medicare are encouraged to follow the WPATH Standards Of Care in seeking Medicare reimbursement and to pre-authorize all surgeries.

News Coverage of Policy Change
National Center for Transgender Equality FAQ on Medicare Coverage
Transmedicare.com – A community run website with good information and a list of surgical providers
Trans Medicare Facebook Group – This is a peer-to-peer group, take advice with a critical lens

Apple Health (medicaid)

AppleHealth

Apple Health (COVERED!)
Apple Health, Washington’s Medicaid program announced a new policy for transgender health in August 2015.

We have produced an extensive Apple Health Frequently Asked Questions on the policy (what is covered, how to access care, etc.)

If you are looking for a surgeon or specific provider information please contact the Trans Health Program at the  Healthcare Authority of Washington.  Phone Number: 360-725-1681

PLEASE NOTE:
Since Apple Health offers a lower reimbursement rate than other health insurance programs, it may take a significant period of time for Apple Health to recruit qualified surgeons into their network.  Before selecting a surgeon, contact the Healthcare Authority to get a list of in-network providers.  Make sure to also screen providers when doing a surgical consultation to ensure they can meet your needs.

To Apply for Apple Health  on Washington Health Plan Finder  (see chart for income guidelines)

TO FIND A PROVIDER:
Washington Apple Health Trans Health Program.
King County 2014 Trans* Resource Guide:  [For Web Viewing] [For Printing]
Ingersoll Gender Center’s Provider Directory 
Providers in Oregon who take Oregon Health Plan (medicaid) List

WHERE TO GET HELP:
Gender Justice League has joined with partners in the Coalition for Inclusive Healthcare to educate legal advocates in assisting our community with health insurance appeals.  Gender Justice League sadly cannot offer case management or assistance – though we can provide you with the basic information about navigating the health insurance process. If you need help appealing a denial – please contact one of these organizations.

Q-Law Foundation Legal Clinic
Northwest Health Law Advocates
ACLU of Washington
CLEAR Hotline – NW Justice Project:

 

TELL US ABOUT YOUR EXPERIENCE
Gender Justice League is a limited capacity organization, we work with partner organizations through the Coalition for Inclusive Healthcare to address ongoing policy issues as they arise.  We also try to connect people who have been denied care by their insurance provider to legal resources to manage their insurance appeal.

What is incredibly helpful to us is to know if you have encountered problems, been denied care, or had difficulty accessing care! 
If you have encountered difficulty with your insurance company, please let us know.   Our advocacy efforts are based off of these reports.