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How does an organization get exclusions removed from a medical insurance policy?

Let me explain my situation: I’m a transsexual woman who works at a private school. Our current health insurance policy explicitly excludes trans-related procedures and treatment. I’ve spoken to my school’s benefits department and they’ve agreed to pay to have the exclusions removed. However, Highmark Blue Shield supposedly claims that it isn’t possible to add or remove conditions like that from a standard plan. Does anybody have any idea how medical insurance policies for larger organizations tend to work in this regard?

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3 Responses to “How does an organization get exclusions removed from a medical insurance policy?”

  1. phlegm said :

    if the school is paying for the coverage they can request what coverages they want. most likely the rates will go up as it will be a customized plan but if they are willing to pay there should not be an issue.

  2. patrick said :

    I would think that the benefits department should know what they can or cannot do with the policy.
    Most likely the insurance company is correct. It wouldnt be prudent to allow a company to change a policy condition, even for increased premiums, as this wouldnt pass the smell test. (Meaning, the insurance company is going to know there is a reason why the client suddenly wants to include transgender services. they can determine that the increased premium is not going to offset the cost).

  3. Insurance said :

    They usually can’t. If it’s a self-funded plan…meaning the company is back it I would assume it’s possible. However, I seriously doubt a school has that type of plan. So, I would go with …’they can’t.”

    I also doubt any insurance anywhere would cover that. Insurance is designed to cover unexpected illness or injury. Even insurance covering maternity is a little outside the box.


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