I got some relatively good news from my insurance company today (I don't think I've ever written or said that before!).

They definitely cover GRS - after I pay a $1500 deductible (which is fine, they cover 100% after that).

Initially I thought they didn't cover breast augmentation as it is listed on the "exclusions" list - but then after the agent said that it should be I found a later reference in the document saying that if, after 12 months of hormones, you don't feel they have grown sufficiently to feel comfortable for your gender, breast augmentation may be covered.  I think since I didn't start HRT until 49 yo it's likely they won't grow that much from hormones alone, so this will probably be covered as well.