HRC’s New Corporate Equality Index Requires Removal of Exclusions to Transgender Healthcare and Bene
October 6, 2010
The following is from Meghan Stabler; Meghan sits on HRC’s Board of Directors and Business Council:
Transgender healthcare coverage and benefits have for too long been excluded from many business’ healthcare plans. It has been a systematic level of discrimination against transgender employees that has a devastating impact on so many people, and it needs to change. In 2002, only 5% of CEI-rated companies included gender identity among their non-discrimination policies and in 2004, only 3% of CEI-rated companies addressed transgender health with limited benefit offerings. Today, 79% of CEI-rated companies provide this limited coverage and 85 companies offer at least one healthcare plan option to all employees that covers many medically necessary transition-related treatments, including hormone therapies and surgeries. Since 2008 I’ve been an active member of the Human Rights Campaign Business Council. Members provide expert advice and counsel on LGBT workplace issues based on their business experience and knowledge.
I, along with all members of the council made it our goal to ensure that we focus on uplifting the requirements for transgender inclusion and provide HR, diversity and benefit administrators with a clear path to remove transgender workplace discrimination and ensure the provision of health insurance. Transgender people are often categorically denied health insurance coverage for medically necessary treatment, irrespective of whether treatment is related to sex affirmation/reassignment. Up until the last few years, nearly all U.S. employer-based health insurance plans contained “transgender exclusions” that limited insurance coverage for transition-related treatment and other care. For any employee, the denial of coverage for medically necessary services and treatments can be both traumatic and life-threatening. Employers, as consumers of group health insurance products, can advocate on behalf of the transgender people insured on their group health insurance plans.
The HRC Corporate Equality Index provides the motivation for employers to work with their insurance carriers or administrators to remove transgender exclusions and provide comprehensive transgender-inclusive insurance coverage. The new CEI criteria raise the transgender benefit provision requirements significantly for employees, their dependents and applies to business operations throughout the United States, including wholly-owned subsidiaries. As part of HRC’s commitment to ending discrimination against transgender people, beginning in calendar year 2011 full credit will be given only to employers offering all benefits-eligible employees (and their dependents) at least one health insurance plan that
- Covers medically necessary treatments without exclusions or limitations specific to transgender individuals or to transition-related care, and
- Conforms to current medical standards of care such as those defined by the World Professional Association for Transgender Health's Standards of Care in determining eligibility and treatment coverage for transition-related services.
In making these changes HRC’s goal remains unchanged; seeking to highlight workplace practices that effectively eliminate discrimination against transgender employees. For the past three years we’ve undertaken a comprehensive review of employer insurance policies and documented tremendous progress. Many businesses have taken steps to remove discrimination from at least one of their health insurance plans for employees and their dependents: Employers of varying size and across industry sectors have successfully introduced coverage inclusive of services related to transgender transition, either at no cost or at a negligible cost. We have also found that placing financial caps for transition related coverage are unnecessary and uncommon and were often utilized to control perceived risk. However, such caps also represent insurmountable barriers to care in many cases. They are discriminatory and the CEI will demand that they be removed. HRC research on utilization has shown that claims costs are extremely low, and therefore risk is low. Only 16 of the 85 businesses currently with full transgender coverage reported a financial cap, ranging from $10,000 to $150,000, and half of these reported caps of $75,000 or greater. In-depth interviews with a subset of employers indicated that there had been little or no initial increase in premiums, that both absolute and annual per employee costs attributed to benefit utilization had been minimal, and that there had been no impact on subsequent premiums. So in summary, much progress has been made by corporations to provide coverage, but work still needs to be undertaken to remove prior discriminatory exclusions for transgender employees and dependents. I truly believe that the latest uplift to the CEI, and the requirement to provide services in order to achieve 100%, will signal a pivotal moment of change for both the employer and transitioning individual. For more information visit www.hrc.org/cei Overview of equal health coverage for transgender individuals in the calendar 2011 CEI: Baseline Criteria
- Insurance contract explicitly affirms coverage
- Plan documentation is readily available to employees and clearly communicates inclusive insurance options to employees and their eligible dependents
- Benefits available to other employees must extend to transgender individuals. Where available for employees, the following benefits should all extend to transgender individuals, including for services related to transgender transition (e.g., medically necessary services related to sex reassignment):
- Short term medical leave
- Mental health benefits
- Pharmaceutical coverage (e.g., for hormone replacement therapies)
- Coverage for medical visits or laboratory services
- Coverage for reconstructive surgical procedures related to sex reassignment
- Coverage of routine, chronic, or urgent non-transition services (e.g., for a transgender individual based on their sex or gender. For example, prostate exams for women with a transgender history and pelvic/gynecological exams for men with a transgender history must be covered)
- Existing plan features should extend equally to transition related care, e.g., provisions for “adequacy of network, ”access to specialists, travel or expense reimbursement
- Dollar caps on this area of coverage must meet or exceed $75,000 per individual
- Coverage available for full range of services indicated by World Professional Association for Transgender Health’s (WPATH) Standards of Care, including the Medical Necessity Clarification Statement
- No Lifetime or Annual Dollar caps on this area of coverage
- Benefit administration covers treatment plans that adhere to the WPATH diagnostic and assessment process.
Eliminates barriers to coverage:
- No separate dollar maximums or deductibles
- Explicit adequacy of network provisions
- No other serious limitations