The HRC announcement painted a rosy picture of transition care benefits: "Removing discriminatory exclusions for medically necessary, transgender-specific treatment is a rapidly-emerging trend"[2] It noted that 18 of the Fortune 100 corporations now offer surgical coverage. But were gains among America's very largest corporations representative of employers surveyed in the 2009 CEI or of those given top ratings?

According to the Employer Database search tool on the HRC web site,[3] the total number of employers surveyed rose slightly to 11,403 from 11,369 last year. While companies given 100% scores rose 1/3, from 195 to 260, the number of 100% CEI employers who cover surgical transition procedures fell from 55 to 47. Firms with 100% scores who cover hormone benefits fell from 85 to 83, and those with top 100% scores who cover transition medical visits fell from 76 to 68. Most disturbing, the number of employers given 100% CEI scores who specifically exclude surgical transition care rose 65% since 2008 -- from 117 to 193. Clearly, the "rapidly emerging trend" is that access to transition care benefits is getting worse among a majority of employers awarded perfect scores by the HRC.

The problem lies in the selection criteria used by the HRC to award CEI scores. Health insurance access for transitioning individuals is only worth five points, and only one of five types of health benefits is required to score all five. They are listed as: "Counseling by a mental health professional; pharmacy benefits covering hormone therapy; medical visits to monitor the effects of hormone therapy and other associated lab procedures; medically necessary surgical procedures such as hysterectomy; or short-term disability leave for surgical procedures."[4] In sharp contrast, domestic partner benefits total 25 of 100 points in the CEI score. Three different types of domestic partner benefits (health insurance; COBRA, dental, vision and legal dependent coverage; plus at least three from a list of other benefits) must be offered by the employer to receive a perfect 100% score.

Consequently, employers have no incentive to offer hormonal or surgical coverage to transitioning employees, and companies who do offer medical transition benefits are not recognized or appreciated. This is in spite of a policy announcement by the American Medical Association last year calling for health insurance coverage of these treatments for what it termed "a serious medical condition" [5] The current CEI criteria send a clear message to employers that the health and lives of transitioning workers are not valued within the GLBT community.

The resulting barriers to health care extend far beyond medical transition itself. Health policy exclusions are often very broadly worded, with phrases such as:

"All expenses related to gender reassignment, including those related to complications arising from such services." [6]

And:

"[treatment] not appropriate based on the gender of the patient."

Thus, post-transition hormone replacement therapy (HRT) that is offered to all other employees may be denied to trans-employees strictly on the basis of their gender identity with consequential medical risk. Coverage for many conditions prevalent among birth-assigned females may be arbitrarily denied to trans-women, if the conditions may be constructed as "complications" of transition. The converse is true for transmen. Also, transmen and transwomen regardless of surgical status may be denied care under the second exclusionary statement, because they possess atypical physiology. For example, the tragic death of Mr. Robert Eads, a trans-man who was similarly refused treatment for ovarian cancer, is chronicled in the award-winning documentary, Southern Comfort. [7] Employers who deny medically necessary transition care, as well as equitable health benefits unrelated to transition, for transsexual employees are not merely rewarded by the HRC, they are held up as models of perfection.

Moreover, the Human Rights Campaign continues to reward, with 100% scores, employers who promote false stereotypes of mental illness for gender variant or transcendent workers. Corporations with discriminatory practices based on these stereotypes still remain eligible for perfect CEI scores. The current CEI criteria allow them to cover mental health counseling for the purpose of "changing" gender identity, discouraging transition or driving trans employees into the closet (known as gender-reparative therapies) and simultaneously deny all benefits for hormonal and surgical transition care.

Such benefit policies reinforce negative psychiatric stereotypes and contribute to a hostile workplace environment. For example, a transsexual woman at my own employer was demeaned and ridiculed as mentally disordered by her supervisor, who told her,

"I don't know why a 'man' would want to cross-dress. You know, the company will pay to fix this condition." [8]

She was terminated during her transition.

Again, there is no stipulation in the CEI selection criteria to suggest that mental health care coverage offered by a 100% company must actually be in support of transition or respectful to the affirmed gender identity of the employee. Of 260 total employers awarded perfect 100% CEI ratings in 2009, over half of them (138) simultaneously cover mental health counseling and deny all surgical benefits to transitioning employees.[9] This raises concern of a growing prevalence of the mental illness stereotype among executives awarded 100% scores by the HRC.

Equally disturbing, the HRC has announced that the CEI criteria will not be updated or corrected for 2010:

"...we will continue to use the rating system we have used since the 2006 Corporate Equality Index. We are committed to giving at least one year's notice for the rating system to change."[10]

Where is the commitment to trans-employees who are denied access to medically necessary care as a consequence of these broken criteria? Corporations who never deserved perfect CEI scores in prior years certainly do not deserve a free pass for another fraudulent perfect score in 2010. It seems unconscionable for the HRC to prolong the suffering of gender dysphoric employees and dependents for the purpose of rewarding health care discrimination.

Please join me in writing Joe Solmonese, Executive Director of the HRC,[11] to press the HRC to require fair access to hormonal and surgical transition care for a perfect 100% score in the 2010 Corporate Equality Index. I also urge you to contact the chief executives of the genuine 100% GLBT inclusive employers, listed below,[12] who already provide hormone and surgical transition care benefits without recognition by the HRC. Thank them for walking the walk, and give them your business and recommend them to friends and colleagues.

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[1] Human Rights Campaign, "Corporate Equality Index," 2009, http://www.hrc.org/issues/workplace/cei.htm

[3] Human Rights Campaign, "Employer Database," 2009, http://www.hrc.org/issues/workplace/search_start_advanced.asp

[4] Human Rights Campaign, "Corporate Equality Index: Current Rating Criteria (2006 - Present)." http://www.hrc.org/issues/workplace/cei_criteria.htm

[5] American Medical Association, "Resolution 122, Removing Financial Barriers to Care for Transgender Patients,"  http://www.ama-assn.org/ama1/pub/upload/mm/16/a08_hod_resolutions.pdf, June 2008.

[6] This language is used by my own employer, a Fortune 20 corporation, to deny coverage for all transition-related medical expenses in health plans administered by Aetna, UnitedHealthcare, and BlueCross BlueShield.  It is representative of common language I have heard in employee and private health plans.

[7] Southern Comfort,  New Video Group, 2001. It may be viewed online at http://www.logoonline.com/shows/dyn/southern_comfort/videos.jhtml.

[8] GID Reform Advocates, Advocates' Statements, http://www.gidreform.org/advocate.html.

[9] Human Rights Campaign, "Employer Database," 2009, http://www.hrc.org/issues/workplace/search_start_advanced.asp This figure was derived by two searches using the Employer Database: 100% employers who cover transgender mental health counseling, and 100% employers who deny surgical care. 138 companies appeared on both lists.

[10] Human Rights Campaign, "Corporate Equality Index: How Can My Employer Participate in the 2010 Survey?" 2009, http://www.hrc.org/issues/workplace/cei_participate.htm

[11] Human Rights Campaign, 1640 Rhode Island Ave., Washington, DC 20036-3278, http://www.hrc.org/

[12]Human Rights Campaign, "Employer Database," 2009, http://www.hrc.org/issues/workplace/search_start_advanced.asp Employers with 100% 2009 CEI ratings who offer health benefits for surgical transition procedures include: 3M Co; American Express Co; AT&T Inc;Cisco Systems Inc.; Coca-Cola Co; DuPont (E.I. du Pont de Nemours); Ford Motor Co.; General Motors Corp; Goldman Sachs Group Inc; International Business Machines Corp. (IBM); J.P. Morgan Chase & Co; Johnson & Johnson; Lehman Brothers Holdings Inc.; Microsoft Corp; Morgan Stanley; State Farm Group; Walt Disney Co; Wells Fargo & Co.;