Gender Identity/Expression and Sexual Orientation Resource Center

Health Insurance for Gender Dysphoria

Washington State University does not provide specific insurance plans for undergraduate students but uninsured students can independently get insurance through the Washington Health Benefit Exchange. 

The Washington Health Benefit Exchange, established as part of national health care reform,
 provides an online marketplace for students to compare low-cost medical insurance options.
 In WA State, this includes expanded Medicaid eligibility and tax credits to offset health insurance costs.

Here are some things to consider as you evaluate your health insurance options:
•As of January 1, 2014 everyone is required to have health insurance. The penalty for being uninsured for the first year is about $100.00.
•The open enrollment period will begin November 15, 2014 and end February 15, 2015.
 You may qualify for special enrollment options if you experience a qualifying life event or are eligible for Medicaid.
•If you are not a resident of Washington, please visit your home state exchange website to learn about your insurance options.

In looking at coverage for gender dysphoria in plans offered through the Washington Health Benefit Exchange it appears as though medical treatment for gender dysphoria is plan specific.  Folks at Student Health and Wellness checked with some of the larger plans like Premera, Lifewise, and Group Health.  With these plans there are benefits, however, there are very specific treatment parameters that must be met before surgical treatment is approved.  It appears as though the hormone therapy and mental health care associated with gender dysphoria is covered by these plans.  The one consistency found with each plan is that they request the prospective insured contact the plan directly with this inquiry.  In other plans such as Bridgespan Health, Moda Health, and Community Health Plan are considering surgery an exclusion from the plan however they may cover hormone therapy on a case by case basis.  There is no coverage under the Apple Health Plans.

 

Sorry there is not an easy answer for this one.  Below are the links to the policy information for some of the plans above.

https://www.premera.com/medicalpolicies/CMI_165435.htm

https://www.lifewisewa.com/medicalpolicies/CMI_165435.htm 

https://provider.ghc.org/all-sites/clinical/criteria/pdf/gender_reassignment_surgery.pdf

http://www.policy.bridgespanhealth.com/medicine/med153.pdf

https://www.modahealth.com/pdfs/med_criteria/GenderReassignment.pdf