Transgender-Inclusive Benefits for Employees and Dependents

Read HRC's White Paper on Transgender-Inclusive Health Care Coverage and the Corporate Equality Index.

Medically necessary treatments and procedures, such as those defined by the World Professional Association for Transgender Health's Standards of Care for Gender Identity Disorders, should be included in employer-provided healthcare and short-term disability coverage.

Transgender people face many forms of discrimination in the provision of health insurance. Employers, as consumers of group health insurance products, can advocate on behalf of the transgender people insured on their group health insurance plans. Employers should work with their insurance carriers or administrators to remove transgender exclusions and provide comprehensive transgender-inclusive insurance coverage.

The American Medical Association  joined the movement to end discrimination in health insurance for transgender people by passing the following resolution at their annual meeting in June 2008:

"RESOLVED, That our American Medical Association support public and private health insurance coverage for treatment of gender identity disorder as recommended by a physician."[1]

Businesses are increasingly addressing this discrimination:

Number and Percentage of Employers with Transgender-Inclusive Health Insurance Benefits

	Fortune 100	Fortune 500	Fortune 1000	AmLaw 200
2011	25 (25%)	39 (8%)	40 (4%)	26 (13%)
2004	1 (1%)	1 (0%)	1 (0%)	1 (0%)

What is the Problem?

• Health Insurance Plans Generally Discriminate Against Transgender People
  Discriminatory trans gender insurance exclusions in insurance contracts cause coverage to be denied for non-transgender care and care related to sex affirmation or reassignment.

Does Your Health Insurance Discriminate?

• Steps for Employers to Determine Whether their Insurance Plan is Inclusive
  Includes specific questions for benefits and human resource professionals to ask their insurance administrators or brokers to find out whether their health plans provide inclusive coverage.
  • FAQ: What are Clinical Guidelines?
• Questions for Employees to Ask to Maintain Privacy
  Questions employees should ask before they ask whether their health insurance provides inclusive coverage.

Countering Misconceptions About Transgender Medical Care

• Treatment is Medically Necessary, Reconstructive and Not Cosmetic
  Treatments and services related to sex affirmation or reassignment are medically necessary when following the internationally accepted standards of care.
  • World Professional Association for Transgender Health's Standards of Care
    The WPATH SOC version 6 from 2001 and as clarified in 2008 are the most commonly used standards.
• Treatment is Not Expensive
  Includes available cost and utilization data demonstrating that costs of treatments are inexpensive and utilization of benefits is low.
• Businesses Can Change their Benefits
  Percentage of Fortune 500-ranked businesses with inclusive coverage. Inclusive self-insured and fully-insured plans are available and attainable (see "Finding Inclusive Health Insurance Plans" below).
  • Corporate Equality Index: Businesses with Inclusive Benefits
    206 businesses rated in the CEI 2012 had provided insurance with at least minimum coverage for sex affirmation or reassignment treatments and services.
  • Colleges and Universities with Inclusive Benefits
    12 colleges and universities provide minimum coverage for students and/or employees.
• Coverage for Medically Necessary Services is Not Taxable

Fixing the Problem: Making Health Insurance Plans Transgender-Inclusive

• Communicating the Availability of the Benefit to Employees
  Employers need to communicate that the benefit is available.
• Finding Insurance for Transgender-Related Healthcare
• Ending Stigma & Achieving Full Inclusion: HRC's Task Force to Address Insurance Industry Practices

Case Studies and Data

• San Francisco City and County
  A detailed look at cost and utilization experience as well as plan evolution from 2001-2006, including official City and County data.
  • Estimating Cost and Utilization for the "Worst Case" (1997-2001)
  • Actual Claims Experience and Plan Evolution (2001-2006)
  • Actual Cost and Utilization (2001-2006)
• Kimpton Hotel & Restaurant
  The company's made its fully-insured health plans inclusive in all the states in which it operates.

Healthcare

Transgender people also face discrimination in the provision of healthcare. Unless an employer operates its own healthcare centers or clinics for employees, it has relatively little control over the provision of healthcare. The Human Rights Campaign Foundation, in collaboration with the Gay and Lesbian Medical Association, provide resources for hospitals on transgender inclusion in patient non-discrimination policies and cultural competency training through the Healthcare Equality Index.

• Healthcare Equality Index
• Transgender-Inclusive Health Care Coverage and the Corporate Equality Index