Ending Stigma & Achieving Full Inclusion: HRC’s Task Force to Address Insurance Industry Practices

HRC has made ending health insurance discrimination against transgender people a primary goal.  To achieve this, HRC seeks to provide employers, health plan administrators, and insurance carriers the tools to offer all employees and dependents health insurance plans that adhere to accepted medical practice, the World Professional Association for Transgender Health (WPATH) Standards of Care (SOC) and that cover all of the reconstructive surgeries and other medical services that are regarded as medically necessary by WPATH.

Beginning with the 2009 CEI, HRC required CEI participants to provide documentation for transgender-inclusive coverage and launched the Transgender Health Insurance Research Initiative (THIRI) bringing in two area expert consultants to aid HRC staff in the comprehensive review of plan documentation and to understand market norms.  Since 2009, HRC has engaged in an ongoing exhaustive review of hundreds of policies to determine both current “best practice” as well as the best possible coverage that is widely available to CEI participating companies. HRC also engaged CEI participants to prepare for stronger standards by generating data and case studies on how businesses could negotiate and provide this coverage.

As of May 2011, HRC had uncovered no commercially available products that contain fully transgender-inclusive healthcare coverage options (including all of the procedures in the WPATH Standards of Care or that adhere to these medical standards in determining eligibility and access). For the 2012 CEI scoring criteria, HRC selected the most aggressive, yet fair and attainable standards.  However HRC strongly encourages employers to aggressively negotiate for full coverage.

To support employers in this effort, and specifically to address the gap between the current product offerings and accepted medical practice, in June 2011 HRC launched an “Insurance Equality Task Force” which will engage in direct advocacy with the insurance industry.  The Task Force brings together top CEI company representatives, insurance experts and other key stakeholders in a shared commitment to end discrimination against transgender individuals and to expand access to this coverage. The main objective of this Task Force is to facilitate the development and availability of health plans and insurance products that provide coverage of medically necessary treatment for transgender individuals in accordance with accepted medical standards.

Currently, the most widely accepted medical standards are the SOC promulgated by WPATH, which brings together health professionals with expertise in this area of treatment. The WPATH SOC articulate the assessment process to be used by providers in guiding treatment decisions to enable provider and patient to identify the treatment pathway that is appropriate for and will be most successful for that individual.

A protocol adhering to WPATH SOC is important because even today many medical providers and third party payers remain unfamiliar with transsexualism and treatment for gender dysphoria.  Adherence to these broadly accepted medical standards ensures that eligibility and utilization management decisions made by health plan administrators are grounded in the treatment protocols used by most experienced professionals today, and that medical decisions and access to treatment are no longer vulnerable to the ignorance and misconceptions born of stigma.