Employee Benefits & Policies Resources

Equal Benefits

Does your health insurance policy’s definition of spouse include same sex spouses AND does your policy require the same documentation for enrollment of same-sex spouses as for opposite sex spouses?

In 2015, the United States Supreme Court determined in Obergefell v. Hodges that same-sex couples have a Constitutional right to marry nationwide. Any business that provides benefits based on marriage to an employee's different-sex spouse must now provide marital benefits to an employee's same-sex spouse.

HRC’s annual review of summary plan documents via the Corporate Equality Index reveals gaps updating the definition of “spouse” for the purposes of defining eligible dependents across benefit plans.

Plans submitted in the 2016 survey included references to the “Defense of Marriage Act” (ruled unconstitutional in the United States v. Windsor in 2013) as well as language that would define a “spouse” as an opposite-sex spouse only. Such language is out of step with the current law, post-Windsor, and post-Obergefell, and should be updated to ensure clear access for all legally wed couples, both same and different-sex.

To receive credit, your facility must meet the following:

Have the health insurance contract definition of spouse include same-sex spouses as well as different-sex spouses AND the health insurance contract has the same requirements for same and different-sex spouses.. “Legally married spouse” (or variations of this) will also count.

Examples of definitions including same-sex spouses:

  • Geisinger Health System clearly defines "legally married spouse" as an individual of the same or opposite gender.
  • Memorial Sloan-Kettering Cancer Center outlines how same-sex and opposite-sex spouses are treated the same for benefits plan purposes.
  • Legacy Emanuel Medical Center explicitly notes that eligible dependents include an employee's legal spouse (same or opposite sex).

Examples of same requirements for same and different-sex spouses:

  • Rush Health’s Benefits Guide includes dependents of same-sex spouses or domestic partners in its description of those eligible for medical coverage. The Guide also requires the same documentation to verify dependents of same-sex and different-sex spouses and domestic partners.
  • Oregon Health & Science University’s Benefit Highlights Guide asks for the proof of relationship documentation for both same-sex and different-sex spouses and domestic partners.
Does your organization offer healthcare benefits to domestic partners of benefits-eligible employees?

To receive credit, your facility must:
Have the 2017 benefits documentation clearly indicate that unmarried domestic partners are eligible for healthcare benefits.

Learn more about why HRC strongly recommends continued provision of domestic partner benefits.
See this piece from the HEI 2017 for more information.

Here are some examples of facilities that offer healthcare benefits to domestic partners:

Does your organization offer FMLA-equivalent benefits that allow employees to take family and medical leave to care for same-sex partners as well as the children of a same-sex partner, regardless of biological or adoptive status?


Here are some examples of facilities that offer FMLA-equivalent benefits:

Does your organization have at least one health plan available to all employees that explicitly covers medically necessary health services for transgender people, including gender transition-related treatment (e.g., hormone therapy, chest/breast and genital surgeries, and mental health services)?

To receive credit, your facility must:
Have equal health coverage for transgender individuals available in at least one firm-wide available plan without exclusion for medically necessary care that meets the following 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

For the HEI, facilities must submit two different documents to validate and prove the availability of these benefits. 

  • The first document needed is your Summary Plan Documentation -- the contract your facility has with your insurer. This SPD will detail the various gender transition coverages available. So when an employee looks at their benefits package (and sees eligibility information, COBRA information, limitations, exclusions, etc), they would see that gender transition coverage is available.
  • The second document needed is the Clinical Plan Bulletin (sometimes called a medical policy) provided by your insurer. This document describes the overall range of gender transition services provided by the insurer. You can look at this listing to see what transgender-related medical services your insurer offers (if any). 
    • Please note that the services of the insurer does NOT mean your organization necessarily offers these services. Your organization’s SPD will describe what specific gender transition coverages you have opted into. 


  • Read this piece from the HEI 2018 on the importance of providing transgender-inclusive healthcare insurance and the related new scoring criteria for the HEI 2019.
  • We encourage you to review HRC’s Trans Toolkit for Employers for a wide range of resources and best practices for employer transgender inclusion. The Toolkit includes HRC’s best practice advice for implementing transgender-inclusive policies (including sample policies) and practices as well as guidance for implementing transgender-inclusive healthcare benefits.
  • Visit our comprehensive resources page on transgender-inclusive benefits for employees and dependents to learn about businesses already addressing the discrimination faced by transgender employees, how to find out if your health insurance discriminates, and how to make health insurance plans transgender-inclusive, along with accompanying case studies.
  • Read HRC’s White Paper on Transgender-Inclusive Health Care Coverage and the Corporate Equality Index.
  • The WPATH Standards of Care are the most widely recognized standards of practice in transgender healthcare. The WPATH Standards of Care have been recognized by the American Medical Association, the American Psychological Association and the National Association of Social workers, as well as in numerous psychiatric textbooks.


  • Legacy Emanuel Medical Center's PacificSource Plan outlines surgical and non-surgical treatments for gender dysphoria that are covered by their plan.

  • The University of Maryland Health Center's UnitedHealthcare Plan affirms coverage for transgender-related healthcare.

  • Memorial Sloan-Kettering Cancer Center offers employees a variety of health plans that explicitly cover medically necessary health services for transgender employees.

  • See page 22 of the City of New York's Summary Program Description for their Health Benefits Program. This SPD clearly indicates how psychotherapy, hormone therapy, and gender affirmation surgeries are covered under all of the health plans offered by the City.
  • Oregon Health & Science University Hospital SPD explicitly lists out the specific procedures and services covered regarding gender reassignment 
  • Henry Ford Health System's SPD details the covered services from their health insurance plan and the exclusions as well

Additional Support for LGBTQ Employees

Does your facility have written gender transition guidelines documenting supportive policies and practices on issues pertinent to a workplace gender transition?

It is often said that when a person transitions gender, everyone around them transitions along with them. In other words, a workplace transition involves change not only for the employee but also for their manager, colleagues and clients.

Business leaders know the importance of proper planning, communication and training in implementing successful organizational change. A successful gender transition is no different. A little planning can go a long way to ensuring a successful outcome for all involved — the transitioning employee, managers, colleagues and clients/customers.

Gender transition guidelines, a written set of guidelines to manage an on-the-job gender transition, outline protocols for gender transitions that clearly delineate responsibilities and expectations of transitioning employees, their supervisors, colleagues and other staff.


Here are some examples of gender transition guidelines:

Does your organization have an officially recognized LGBTQ employee resource group?


  • Visit our comprehensive page on LGBTQ employee groups to learn about the different types of groups organizations have, the objectives of such groups, see example established employee resource groups, and more information on establishing an employee group or expanding your existing group.


  • See Nationwide Children's Hospital's LGBT Employee Resource Group webpage.
  • See Henry Ford Health System’s PRIDE group brochure.
  • See Contra Costa Regional Medical Center’s LGBT Employee Resource Group flyer.
Does your organization have an organization-wide diversity and inclusion office, diversity council or working group focused on employee diversity that specifically includes LGBTQ diversity as part of its mission?


  • ContraCosta Regional Medical Center created this flyer to inform employees of their working group that specifically includes LGBTQ diversity as part of its mission.
  • This webpage for the Mount Sinai Office for Diversity and Inclusion lists out their areas of focus, which include the LGBTQ population.
  • Learn more about the Diversity Equity & Inclusion Council at Cooley Dickinson Health Care on this page.
  • The Diversity program at Thomas Jefferson University has some interesting programs to promote LGBT diversity.
Does your organization conduct anonymous employee engagement or climate surveys that allow employees to identify as LGBTQ?


  • See our page on self-identification of LGBTQ employees to learn more about asking these questions and why anonymity is so important to employees who disclose their LGBTQ status.
  • See the Corporate Equality Index's document on collecting SOGI data from employees
  • Read the Williams Institute publication Best Practices for Asking Questions about Sexual Orientation to learn more about why collecting this data is important, what questions to ask, and how and where to ask them.
  • If your hospital or health system uses Press Ganey for your Employee Engagement Surveys, Press Ganey now has new demographic measures for sex, gender identity and sexual orientation. You should contact your Account Manager to add SOGI options to your surveys. We encourage you to review the best practices listed above before determining your response options and we strongly discourage you from using the "transsexed" and "transitioning" response options to the question about sex.   


  • After completing a Work Culture survey, Fenway Health asks employees about their sexual orientation, gender identity and sex assigned at birth.​
  • Saint Barnabas Medical Center administered an anonymous survey to their staff which included questions on their staff's gender identity and sexual orientation. 
  • In their employee engagement survey, Whitman Walker makes sure to collect SOGI information on their staff. 
Does your organization conduct an anonymous employee engagement or climate surveys that include questions related to LGBTQ concerns?


  • Some example questions for this survey might be (but are not limited to):
    • Does this organization value differences in age, gender, sexual orientation, gender identity or expression, and race or ethnicity? Measure level of agreement and rating scale.
    • Are diverse people (differences in race, gender, age, religion, sexual orientation, gender identity etc.) treated fairly at this organization?
    • Do all staff members have an equal opportunity for promotion regardless of race, religion, gender, sexual orientation, age, ethnic background, national origin, or disability?
    • Have you personally witnessed or experienced discriminating behavior at work, on the basis of some diversity-related characteristic in the past twelve months?
    • Identify the type of discrimination that occurred, including sexual orientation and gender identity as an option.
    • For more example questions and a comprehensive review of the workplace climate for LGBTQ people, see our Degrees of Equality Report detailing how LGBTQ identity surfaces and unfolds in the workplace, and how organizations can identify and address opportunities to improve climate and drive up performance and retention.
  • If your hospital or health system uses Press Ganey for your Employee Engagement Surveys, Press Ganey now has new evaluative measures for sex, gender identity and sexual orientation. You should contact your Account Manager to add SOGI options to your surveys. 


  • NYC Health and Hospitals asked staff questions related to LGBTQ self-identification and distributed an LGBT Health Needs survey.
  • Kaleida Health released a climate survey for employees to determine how inclusive their facilities are to the LGBTQ community.
  • This anonymous LGBTQ climate survey helps Boston Children’s Hospital garner vital data to improve employees’ experiences, as well as patients and their families.
Does your organization commemorate an LGBTQ Awareness Day each year for employees?


Some LGBTQ holidays your facility might celebrate include (but are not limited to):

  • International Transgender Day of Visibility
    Observed each year on March 31st to celebrate the courage it takes to live openly and authentically while also recognizing the leadership of transgender and gender nonconforming trail blazers who have led the charge in the fight for equality.
  • LGBTQ Pride Month
    Occurs annually during the month of June (although Pride celebrations may be held during other times of the year). Pride is a time when many cities and towns host Pride parades, movie screenings, symposia, and more to celebrate LGBTQ history and identities.
  • Celebrate Bisexuality Day
    Falls on September 23rd annually as a day to recognize and celebrate the bisexual community.
  • LGBT History Month in October
    Celebrates the achievements of lesbian, gay, bisexual or transgender icons. The month provides role models, builds community and makes the civil rights statement about the LGBTQ community’s national and international contributions.
  • National Coming Out Day
    Occurs on October 11th every year as a day to celebrate coming out as lesbian, gay, bisexual, transgender, queer or as an ally.
  • Spirit Day
    Observed annually on October 16th where millions of people wear purple to stand against bullying and show their support for LGBTQ youth.
  • Transgender Day of Remembrance
    Occurs annually on November 20th as an opportunity for communities to come together and mark the passing of transgender and gender-variant individuals—or those perceived to be transgender—who have been murdered because of hate.


  • VA Central Texas Veterans Health Care System created a festive flyer to promote their Pride celebration event.
  • NYC Health and Hospitals – North Central Bronx held an internal celebration before they attended New York City Pride.
  • For Pride month, VA Minneapolis Health Care System promoted a lunch and learn presentation to discuss LGBTQ issues in the workplace.
  • VA Robley Rex Medical Center’s internal ceremony to celebrate their Leader designation to celebrate Pride.
  • View Anderson County Hospital’s internal event with cupcakes to celebrate LGBT History Month.    
  • Clinical staff at Crittenton Children’s Center created an interactive presentation at their “Dance to Your Own Music” event to celebrate LGBT History Month.
  • Northwell Health celebrated National Coming Out Day while also promoting their employee resource group and HEI participation.
Are your organization’s hiring/recruitment efforts explicitly LGBTQ-inclusive?

To receive credit, your facility must:
Demonstrate how hiring efforts are proactively LGBTQ inclusive. Simply having an employment non-discrimination statement that includes “sexual orientation” and “gender identity” posted on job descriptions or career website does not count for this criterion, however, it does count for publicly communicating you employment non-discrimination policy.

Organizations can target potential LGBTQ employees in a variety of ways:

Job postings are sent to LGBTQ organizations and/or print/online LGBTQ publications

  • For more information on LGBTQ-inclusive hiring and recruitment, visit our webpage detailin LGBTQ recruitment and LGBTQ-specific job sites.
  • Northwell Health utilized an LGBTQ job search website to recruit for open positions.
  • See an example of a LGBT job ad from the VHA.

Organization has hiring/recruitment brochure explicitly targeting LGBTQ people

  • See Truman Medical Center’s brochure on their commitment to LGBT community, highlighting the LGBT employee benefits at their facility.
  • VA Palo Alto Healthcare System has an LGBT specific employment brochure.
  • View Oregon Health & Science University’s flyer as an example of LGBTQ inclusive hiring materials.
  • Wm. Jennings Bryan Dorn VA Medical Center’s LGBT employment program also has an employment brochure that emphasizes their diversity and inclusion of LGBT employees.

Organization attends LGBTQ job fairs

  • See our page on LGBTQ professional recruitment events to find recruitment or career events with a national focus. You can also reach out to your local LGBTQ community center to see if there is an LGBTQ job fair in your area.
  • MetroHealth hosted a Transgender Job Fair at their facility to recruit prospective talent in northeast Ohio.
Does your organization have one or more openly LGBTQ people serving in a high-level leadership position that is visible organization-wide?

Note: We are looking for a senior/executive-level administrator at your organization.

The presence of visible LGBTQ employees in management communicates to the LGBTQ employees of your company that their company is open and accepting and enables LGBTQ employees to be open at work, which in turn improves their engagement and retention.