Transgender employees and employees who have transgender dependents will want to know how their employer's health insurance plans treat transgender people, regardless of their medical needs, and what medical providers are available to them as part of their health insurance's provider network.
This page is part of a set of resources for employers to implement transgender-inclusive health insurance coverage. See "Transgender-Inclusive Benefits for Employees and Dependents" for the complete set of resources.
Discrimination persists in the provision of medically necessary care and the related insurance coverage of that care for transgender people, irrespective of whether that care is related to sex reassignment or affirmation or even if the individual has no intention of undergoing such treatment.
As a result of this discrimination, transgender employees and employees who have transgender dependents will want to know how their employer's health insurance plans treat transgender people, regardless of their medical needs, and what medical providers are available to them as part of their health insurance's provider network.
Existing federal and state laws generally do not provide much guidance: many jurisdictions have laws that prohibit employment discrimination based on gender identity and many employers have equal employment opportunity or non-discrimination policies that prohibit discrimination based on gender identity — but these laws and policies generally do not directly affect insurance.
Finding this detailed level of information about insurance is often, at best, a difficult and confusing process for anyone — transgender or not. By law, employers are required to make summary information about their health insurance plans readily available to employees, but such documentation is not always up to date in practice and, particularly for transgender-related concerns, can provide ambiguous information. At some point, the employee will likely want to reach out to a human being to ask questions, but this could potentially disclose an individual's transgender status.
State and federal laws, including the Health Insurance Portability and Accountability Act (HIPAA), govern the privacy of health information among healthcare providers and insurance plans — and not employers. But some employers are self-insured, meaning that they fund their own health insurance plan and thus act as the insurer for employees' and their dependents' medical needs. When acting as the insurer, the employer must comply with HIPAA. Self-insured employers typically utilize a third party administrator (TPA) to manage the plan. In these cases, the TPA would be required to comply with HIPAA.
Because so many arrangements are possible, it can be hard to find the person who can talk to you about your benefits but who is also required by law to keep your informaton private.
It important for employees to be cautious about any discussions they have that might disclose their transgender status. The following guidance is intended to help ensure that conversations you may have with any representative of your employer or your health insurance plan are protected and treated appropriately.
Because most insurance information is considered proprietary and most employers rely on a third-party insurance administrator to manage its health insurance, you may have to provide and/or verify your employment information (i.e., to verify that you are a plan participant/member) in order to get answers to questions about your plan. Before asking about transgender-inclusive health insurance options under your employer's health insurance plans, check your existing benefits documentation for contact information. Even if it has reassuring privacy disclaimers, you may wish to reach out to the phone number provided (you may wish to use a non-work phone number, if possible) and ask:
"I want to have a conversation with you. I have specific questions about my benefits and I want to make sure that my privacy is protected.
- Are you familiar with and aware of HIPAA privacy law and regulations? (Positive answer: "Yes")
- Are you covered by them? (Positive answer: "Yes")
- Can I have a conversation with you about specific benefits that is protected by HIPAA? (Positive answer: "Yes")
If you don't know, can you direct me to someone else that might know/be covered by HIPAA?"
When you have established contact with someone who can answer these questions affirmatively, you should feel more comfortable asking detailed questions about your coverage relating to transgender medical care. A further precaution might be to have the individual you've connected with e-mail you a statement affirming that conversations you have will be protected by HIPAA.
Regardless, there is no guarantee that any individual who is covered by HIPAA will not make a mistake and share your information in a way that they should not — always use your discretion and caution.
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