Princeton University Health Services (UHS) is dedicated to respecting the rights and welfare of the Transgender and Gender Diverse community by acknowledging that gender does not exist on a binary. UHS strives to validate, and normalizes gender diversity and opposes all public and private discrimination on the basis of actual or perceived gender identity and expression. UHS recognizes that gender diversity is not a mental disorder and therefore condemns all forms of conversion therapy as unethical and iatrogenic. Further, UHS calls upon healthcare professionals to take a leadership role in working against discrimination towards Transgender and Gender Diverse individuals. In line with the best practices developed by the world’s leading medical and psychological associations, UHS supports transgender and gender nonbinary students’ access to gender affirming care, including but not limited to the initiation and continuation of gender affirming hormones and insurance coverage of surgeries and procedures for gender affirmation. We understand that navigating insurance coverage is challenging, and we want to support you as you navigate your health options. Learn more about: UHS services for students Process for gender affirming hormone therapy (feminizing or masculinizing hormones) Process for gender affirming surgeries and procedures Aetna Student Health Plan (SHP) insurance coverage UHS Queer Trans Plus (QT+)Team Gender affirming campus resources COVID communications UHS contacts Video from Provider Panel (June 3, 2020) UHS Services The following UHS services are available to Princeton undergraduate and graduate students, regardless of insurance provider: Medical Services Free, inclusive primary and sexual and reproductive health care. Consultation, informed consent, and medication management for gender affirming hormones. Information, referrals, and guidance for gender affirming surgeries and other office procedures not available at UHS. Pre-operative physical health assessments for gender affirming surgeries. Letters for traveling with medications. Counseling & Psychological Services (CPS) Free, confidential, supportive, and gender affirming counseling for any issue, including experiences and questions related to gender identity. Some medical providers, outside of UHS, request that you provide a letter from a mental health professional when accessing certain gender-affirming medical care. CPS can work with you to provide such letters. Quest Laboratory On-site laboratory for blood and urine tests. There may be a charge associated with these tests. Student Health Plan (SHP) Office Consultation/information about the Aetna Student Health Plan (SHP) and OptumRx Prescription Plan. Process for obtaining gender affirming hormone therapy (feminizing or masculinizing hormones) Gender affirming hormones are essential primary care for many transgender and gender non-binary individuals. UHS utilizes an informed consent model1 to initiate and/or continue gender affirming hormones. Regarding insurance If you are enrolled in the Student Health Plan, while not mandatory, we encourage you to schedule an appointment with the Student Health Plan office, to discuss insurance coverage and answer any questions you might have, by emailing [email protected] or calling 609-258-3138. For students who are not enrolled in the Student Health Plan, we recommend you reach out to your insurer to gain a full understanding of the coverage available to you. Appointments Medical appointments can be scheduled with Rebecca Donn, WHNP-BC, Valerie Lewis, M.D., MPH, or Maureen McSorley, APN, by calling the McCosh Health Center front desk at 609-258-3141 during normal business hours, or online. When you make your appointment over the phone, you do not have to disclose what your appointment is regarding if you are not comfortable doing so. It is ok to tell the client service representative that you are scheduling for “concerns.” Initiating or starting hormones involves reviewing your medical history and goals and the risks, benefits, and alternatives with a medical provider. You may be prescribed hormones at your initial visit but you or your medical provider may decide you need more time to consider your options or time to consult with other members of your health care team to determine safety. Once you start hormones, you will be scheduled for a follow up appointment at least every 3 months until you reach your desired dose, you will then follow up every 6-12 months. You will likely have blood testing done at each follow up visit. Prescriptions for hormones Prescriptions for hormones are sent electronically to the pharmacy of your choice. Most students who live on or close to campus use the CVS on Nassau Street. If you are enrolled in the Student Health Plan, prescriptions for hormones are covered. Visit the SHP website to learn more about your prescription/medical benefits or to contact the SHP office for additional information. If you are not enrolled in the Student Health Plan, you will need to contact your insurer/prescription benefits carrier to learn about your coverage. Process for obtaining gender affirming surgeries and procedures If you are on the Student Health Plan: The SHP covers medically-necessary gender affirming surgeries and procedures as well as other procedures that may be required to preserve fertility options when initiating masculinizing or feminizing hormones. Aetna is the company that processes Student Health Plan claims, and they require that a pre-certification be completed by staff at UHS before any reimbursement or contract agreements with surgeons can be completed. Below are the steps of the process needed to ensure a smooth process for payment or reimbursement: We encourage you to contact the Student Health Plan office at [email protected] to discuss insurance coverage and to answer any questions you might have. Consultation(s) with surgeons – if you are considering a gender affirmation procedure, it is important that you schedule a consultation with your surgeon. UHS/the SHP do not require that you use a specific surgeon for your surgery, however surgeons who are listed as Preferred Care Providers2 within the Aetna network facilitate a smoother process for insurance claims. If your surgeon requests that you provide a letter or have a consultation with a mental health provider, counselors at CPS are available to meet with you. If you are having difficulty finding a gender affirming surgeon, please feel free to reach out to Valerie Lewis, M.D., MPH, at UHS, and they will support you in your search. You may also schedule an appointment by calling a McCosh Health Center front desk at 609-258-3141 during normal business hours. Once you have decided on the surgeon and specific surgery(ies) you will have, the next step is to schedule an appointment with Rebecca Donn, WHNP-BC, or Valerie Lewis, M.D., MPH, to discuss your plans. Specific information from your surgeon may be required, including: Name, office address and phone number of surgeon. Name, address, and phone number of hospital or outpatient facility where surgery/procedure will occur. Anticipated date of surgery/procedure. CPT3 codes for the planned surgery/procedure(s). Specific billed charges associated with each CPT code. If you are able to obtain this information from your surgeon, please bring it with you to your visit at UHS. If you are not able to obtain this information, UHS will request permission to call your surgeon’s office to obtain this information to complete your pre-certification. After all of the above information is received, the UHS pre-certification will be completed and communicated to Aetna. Aetna will process the information and contact your surgeon’s office to confirm reimbursement. Most surgical offices have experience working with Aetna, but they may not be familiar with the Princeton SHP. The Princeton SHP is a self-insured plan that is only for Princeton’s students and eligible dependents. You can expect the Student Health Plan to pay 90% of any medically-necessary surgery, if you’re using an in-network provider. This means that you are responsible for the remaining 10% of surgery cost, up to $5000. If you are using an out-of-network provider, the Student Health Plan will pay 70% of any medically-necessary surgery. This means that you are responsible for the remaining 30% of the surgery cost, up to $5,000. The Student Health Plan office can explain coverage, in-network and out-of-network providers, and anticipated out-of-pocket costs. Email [email protected] or call 609-258-3138. If you are not on the Student Health Plan: Contact your insurer to learn what coverage is available for gender affirmation procedures. If your carrier does not cover these procedures, you have the option of paying out of pocket for your procedures. Alternatively, you have the option of enrolling in the Student Health Plan during the annual enrollment period, which takes place in late spring for the following plan year and runs from September 1 to August 31. Every year there is an opportunity to enroll in the SHP during the open election period which typically starts in late May. Aetna Student Health Plan (SHP) coverage/details Covered Medical Expenses under the SHP include charges incurred by a covered person for medically-necessary surgery, mental health, prescription drugs, and other related services. All surgical procedures require consultation with a UHS medical provider and pre-certification. The SHP covers 90% of the negotiated or recognized charge for covered medical expenses related to gender affirmation after applicable deductibles are met. See the SHP Document (.docx) for information on eligibility, annual plan deductible precertification requirements, and out of pocket maximums. UHS Queer Trans Plus (QT+) Team The UHS Queer Trans Plus (QT+) Team is rooted in gender affirming models of care4 and espouses the following values: no gender identity or expression is disordered; gender is impacted by other identities and culturally informed; “gender involves an interweaving of biology, development and socialization, and culture and context, with all three bearing on any individual’s gender self” (p. 285); gender may be fluid across time as well as in a particular moment in an individual’s life; pathology is not caused by or associated with variations in gender identity and expression. The UHS QT+ Team endorses the mission of the World Professional Association of Transgender Health (WPATH) and seeks to “promote evidence-based care, education, research, advocacy, public policy, and respect to transgender health” (2019). The UHS QT+ Team aims to: increase access to continued education; improve service to transgender and gender diverse student and dependents; collect data about communities served and engage with other gender affirming health providers. These priorities allow the UHS QT+ Team to act as an advising body of UHS, where the Team is prepared to act as a consulting body to UHS leadership with regards to any changes to access to care, services, promotion, and policy as it relates to transgender and gender diverse students and dependents. This may include, for example, informing and providing consultation on changes to insurance coverage and complex health care cases. The current UHS QT+ Team includes representation from Athletic Medicine, Health Promotion & Health Services (HPPS), Infirmary, Student Health Plan, Medical Services, Information Technology, Counseling & Psychological Services (CPS), and the SHARE office. Current Members: Annette Macaluso, Bridget Hunt, Calvin R. Chin, Carrie Genovese, Gavin Jones, Jacqueline M. Deitch-Stackhouse, Janet E. Finnie, Janine D. Mascari, John Walker, Joseph F. Cooper, Judith E. Oakley, Kim Meersma, Melanie D. Jeitner, Rebecca J. Donn, Steph Vituccio, Valerie J. Lewis Co-Chairs: Rebecca Donn and Gavin Jones Gender Affirming Campus Resources In addition to the gender-affirming services available at UHS, Princeton University offers a a variety of resources for gender diverse students, staff, and faculty. To learn more about these resources, contact the Gender + Sexuality Resource Center by emailing [email protected]; or calling 609-258-1353. Highlighted resources: Legal Name Change (The GSRC is able offer support to students navigating the legal name change process, this may include financial support and access to legal advice). Map of gender inclusive and single-stall restrooms Gender and Sexuality Basic Needs Fund COVID Communications Some of our current COVID Communications systems, which are contracted to an external company, do not allow for current name to replace legal name. We acknowledge the potential harm and distress to trans and other gender non-conforming individuals because of this systematic failure and apologize as it does not meet our standards for gender-affirming care at University Health Services. Within the next few weeks, we will be transitioning to an internal system that reflects current, not legal name for most of our COVID-related communications; however, all test results will still be reported with legal name, because of New Jersey Department of Health requirements, this should also allow your COVID testing documents to align with your legal documents like passport, license, etc. for the purposes of travel. If you would like to provide feedback, email the UHS QT+ Health Team Co-Chairs Rebecca Donn or Gavin Jones. If you want to learn more about how the University can support you through the legal name change process, email the Gender + Sexuality Resource Center. UHS Contacts Student Health Plan Office McCosh Health Center, G24 Email: [email protected] https://uhs.princeton.edu/student-health-plan Phone: 609-258-3138 Rebecca Donn, WHNP-BC, Co-Chair QT+ Team McCosh Health Center, First Floor Email: [email protected] Phone: 609-258-3141 Valerie Lewis, M.D., MPH McCosh Health Center, First Floor Email: [email protected] Phone: 609-258-3141 Maureen McSorley, APN McCosh Health Center, First Floor Email: [email protected] Phone: 609-258-3141 Gavin M. Jones, LSW, Co-Chair QT+ Team McCosh Health Center [email protected] 609-258-6273 Video from Provider Panel (June 3, 2020) 1"Informed consent" means that UHS will provide you with the most up-to-date information about benefits and known risks associated with procedures or treatments and help you decide whether that procedure or treatment is right for you and your body. 2 As an enrollee on the Student Health Plan, you have access to the Aetna Preferred Provider Network. To reduce your out-of-pocket expenses, select a Preferred Provider. It may be to your advantage to use a Preferred Provider due to the Negotiated Charges these providers have agreed to accept as payment for their services. 3 "CPT codes" stand for “Current Procedural Terminology” and are standard codes that any surgeon in the U.S. will be able to provide. 4 Hidalgo, M. A., Ehrensaft, D., Tishelman, A. C., Clark, L. F., Garofalo, R., Rosenthal, S. M., Spack, N. P., Olson, J. (2013). The gender affirmative model: What we know and what we aim to learn. Human Development, 56, 285–290. http://dx.doi.org/10.1159/ 000355235
