Trans Health Services and UC SHIP Insurance
We use the term trans as an umbrella term that includes folks who identify as trans, transgender, non-binary, genderqueer, gender non-conforming, gender questioning, agender, gender creative, gender fluid or elsewhere on the gender spectrum.
Please be aware that certain providers have more experience in transgender care, therefore please indicate that you are interested in obtaining transgender care when you make your appointment.
Overview
Student Health Services (SHS) and Counseling & Psychological Services (CAPS) provides on-site trans healthcare services at the H. Rajender Reddy Health Center. The UC Student Health Insurance Plan (UC SHIP) covers health treatment and care services for trans folks seeking hormone therapy and gender confirmation surgeries. This page is meant to provide a general outline of what services are available to students through both UC SHIP. Specifics regarding physical aspects of transitioning should be discussed with your SHS health provider (or your provider through your private health insurance plan). Further questions regarding insurance coverage through UC SHIP can be discussed with the SHS Insurance Services staff at the H. Rajender Reddy Health Center. Also, the recommended online resources at the bottom of this page link to websites that cover important related topics in greater depth.
What Does UC SHIP Cover?
UC SHIP is a comprehensive insurance plan with extensive medical and mental health coverage for trans care. Hormone therapy is a benefit covered by UC SHIP for the appropriate co-pay. Most pharmacies in the area provide convenient direct billing for SHIP enrollees with a low co-pay option.
If you choose to pursue Gender Confirmation Surgery, UC SHIP will cover a large percentage of the costs associated. How much of the cost covered depends on where you receive care. If you receive care with a “UC Family” provider, such as the UC Davis Medical Center or one of the other UC Medical Centers, including the UCSF Medical Center, then treatment services are covered at 90%, and the annual deductible is waived. If you receive care out-of-network, transgender surgery is payable at 60%. There is no lifetime maximum on the gender confirmation surgery benefits.
If you receive care with an Anthem Blue Cross contracted provider not affiliated with the UC health system, then services are covered at 80%, after you have met your $200 annual deductible. Out-of-network providers may also contract independently with UC SHIP to offer medical or surgical care at variable out of pocket costs to students on the plan.
Following a provider order or referral, UC SHIP covers hormone therapy and the following Gender Confirmation Surgeries:
- Chest Surgery (“Top” Surgery): Breast removal and nipple reconstruction
- Gonadal Surgery: Removal of Uterus and Ovaries or Orchiectomy (Testicles)
- Female Genital Confirmation Surgery
- Male Genital Confirmation Surgery
- Laser hair removal (neck, face)
- Fertility preservation
Talking to UC Merced Insurance Services staff about where you may want to receive care will help you get a better idea of the exact cost of care. Not all surgical procedures related to transitioning are covered by insurance. The surgical procedures related to transitioning that are not covered by UC SHIP are:
- Reduction thyroid chondroplasty (reduction of Adam’s apple)
- Liposuction (body fat removal)
- Rhinoplasty (nose reconstruction)
- Facial bone reconstruction
- Face lift
- Blepharoplasty (eyelid reconstruction)
- Voice modification surgery
- Hair removal/hair replacement
- Breast augmentation
As a general reminder, when visits at SHS have a copay, the student will be responsible for covering this cost. Please see the SHS fee schedule for details.
If there are travel expenses in connection with an authorized transgender surgery performed at a facility which is designated by the claims administrator and approved for the transgender surgery requested, claims can be made for reimbursement (provided the expenses are authorized by the claims administrator) for up to six trips. Travel expenses may include:
- Round trip coach airfare to the facility which is designated by the claims administrator and approved for the transgender surgery requested, not to exceed $250 per person per trip.
- Hotel accommodations, not to exceed $100 per day for up to 21 days per trip, limited to one room, double occupancy.
- Other expenses, such as OTC medical supplies, not to exceed $25 per day for each person, for up to 21 days per trip. Meals are not covered.
Charges for services that are not authorized, or which are provided in a facility other than which the claims administrator has designated and approved for the transgender surgery requested, will not be considered covered expenses.
Other Trans Healthcare
Routine preventive care and monitoring of hormone-related physical, emotional and metabolic effects should be part of regular health maintenance and wellness care. Some health conditions or health risk behaviors like cigarette smoking may be significantly more important to address as part of transition.
If you smoke cigarettes, ceasing tobacco use is a health conscious move, particularly if you plan on starting hormone therapy. Tobacco increases the risk of heart and lung disease, especially in people taking hormones. Smoking cessation can be discussed with your healthcare provider when you go into your initial appointment, or you can make an appointment with the Alcohol, Tobacco and Other Drugs Intervention Services Coordinator, by logging into your health e-messaging. When asked to “Select Appointment Category,” click on “Tobacco/Smoking Cessation."
Other types of healthcare are also exceptionally important for trans individuals. For example, some trans men could still be at risk for breast, cervical, uterine and ovarian disease if they have not undergone surgery to remove these body parts. Penile, testicular and prostate disease is also a risk for trans women who have not undergone removal surgery. Talk with your provider about what checkups should be done regularly in order to ensure your health.
Future fertility and contraception remain important considerations for trans patients. Fertility preservation through sperm banking is covered by many insurances. Individuals needing contraception can obtain this as a covered benefit without co-pay or deductible on all ACA-compliant insurance plans.
Other Trans Health Topics
A visit with a mental health provider at Counseling & Psychological Services (CAPS) is a great place to start when pursuing your desire to initiate transition care. CAPS mental health staff have experience and training in working with trans students. CAPS offers an extensive staff of counselors to choose from. Visit the CAPS Meet the Staff page to view the biographies of UCM Counseling Services Clinical Staff.
If you are considering starting hormone therapy, one of the first steps is talking with a SHS medical provider who will guide you through the process. Not all providers initiate transition medications, but all can begin the basic health assessment process. It is always important to have a baseline medical evaluation prior to initiating hormone treatment. Hormone medication treatment is anticipated to be lifelong therapy and it is important to fully assess your health status, personal health risks and potential future health needs before starting.
Following your assessment, an SHS medical provider will give you in-depth information about the hormones you will be receiving and the potential risks, benefits and limitations of medications used. An informed consent process ensures you and your provider have fully communicated important health information and you have had the opportunity to ask, and have answered, all questions you have regarding care.
In some cases, before giving you a prescription for hormones, your medical provider will refer you to a mental health professional if you have not previously been working with one. This mental health referral offers you the opportunity to receive services from a professional who will discuss your desire to transition and can assess any mental health needs that should be addressed or considered either before or at the time of hormone therapy initiation. Some insurance plans require that this therapist write a letter to your medical provider indicating that you are eligible and ready to start hormone therapy. The UC SHIP insurance plan does not require a mental health provider letter to start hormone therapy. However, UC SHIP benefit coverage requires one therapist letter to undergo breast removal (aka “TOP” Surgery) and a total of two letters, one letter each from two different mental health professionals, to undergo gonad removal or genital confirmation surgery.
Resources
UC Merced's LGBTQ+ Initiatives
Transgedner Resource Committee
Sexual Health and Fertility: Trans Men and Trans Women (UCSF’s Center of Excellence for Transgender Health)
Surgical Options (UCSF’s Center of Excellence for Transgender Health)
Information on Hormones: Estrogen and Testosterone (UCSF’s Center of Excellence for Transgender Health)
