2017 CEI Criteria - Health Insurance for Transgender Employees and Dependents

Filed under: Workplace

Updated on 02/01/2017

  1. Insurance contract explicitly affirms coverage and contains no blanket exclusions for coverage.
  2. Insurance contract and/or policy documentation is based on the World Professional Association for Transgender Health (WPATH) Standards of Care. Documentation must be sent to the HRC in order to confirm compliance. 
  3. Plan documentation must be readily available to employees and must clearly communicate inclusive insurance options to employees and their eligible dependents.
  4. Benefits available to other employees must extend to transgender individuals.The following benefits should all extend to transgender individuals, including for services related to gender transition (e.g., medically necessary services related to sex affirmation/reassignment):
    • Short term medical leave
    • Mental health benefits v. 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/gynaecological exams for men with a transgender history must be covered.)
    • Plan language ensuring “adequacy of network” or access to specialists should extend to transition-related care (including provisions for travel or other expense reimbursements)
    • Dollar maximums on this area of coverage must meet or exceed $75,000. 

 

Helpful Resources

 

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Transgender-Inclusive Health Insurance