Kelley Winters

HRC Corporate Equality Index Revisions are Great, but 2012 is Much Too Late.

Filed By Kelley Winters | March 10, 2009 10:30 AM | comments

Filed in: Politics, Transgender & Intersex
Tags: CEI, Corporate Equality Index, employment protections, HRC, Human Rights Campaign, transgender, transgender health, workplace equality

Last week, the Human Rights Campaign Foundation announced long awaited revisions to its Corporate Equality Index (CEI) that would address some of the current inequities in transgender health benefits. Employers receiving a perfect 100% rating would be required to remove trans-specific exclusions from medical plans. The announced changes to the CEI criteria would represent substantial forward progress from the existing policy, which currently awards perfect 100% scores to large numbers of employers who exclude coverage of medically necessary transition care.

I applaud the HRC for stepping up with these improvements to the CEI criteria, and I appreciate many years of struggle for policy reform by trans-representatives and allies on the HRC Business Council. There is just one big problem: the revised criteria will not take effect until the 2012 CEI. According to a published HRC time-line, corporations receiving perfect scores will not be required to meet the new benefits requirements until January 1 of 2012. In other words, Rush Limbaugh and Sarah Palin might mudwrestle for the Iowa Caucuses well before trans employees see health benefits relief under the Corporate Equality Index scoring criteria.

The Good News.

In a post here at the Bilerico Project, HRC Workplace Project Research Coordinator Samir Luther announced that the announced "3.0" criteria, "will take the CEI and its participants to a more holistic level of LGBT workplace inclusion in the U.S."[1] Specifically, the new criterion for Health Insurance for Transgender Employees and Dependents states:

Benefits-eligible employees and dependents firm-wide must have access to at least one health insurance plan that:

  1. Covers transgender-specific treatment (mitigating "transgender" or similar exclusions for care) and
  2. Affirmatively recognizes the WPATH Standards of Care in determining treatment coverage eligibility (mitigating "medically necessary" and "cosmetic" exclusions).[2]

The first item does not specify what hormonal or surgical transition procedures must be covered to qualify for a 100% CEI rating, however it does imply that some kind of "transgender-specific treament" must be covered. It further states that transgender-specific exclusions to care must be "mitigated." As I noted last week,[3] health policy exclusions targeting trans-people are often very broadly worded, with phrases such as:

All expenses related to gender reassignment, including those related to complications arising from such services.

And:

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

These exclusions extend well beyond transition-related treatments to implicate any medical condition that might be construed as a "complication" of transition or related to anatomy or physical sex characteristics that are atypical. Examples of the latter might include denial of cervical cancer screening for a transman or prostate cancer screening for a transwoman. The HRC is correct to address exclusions that specifically target trans employees and dependents, however the criterion fails to explain how they should be "mitigated" or why they should not be eliminated completely.

The second line item requires that health benefit policies must reference the Standards of Care (SOC) published by the World Profession Association for Transgender Health (WPATH).[4] The current SOC remain controversial to many in the trans-community, with issues of inflexibility, fixation on binary gender stereotypes, and reliance on misleading psychiatric diagnostic nomenclature.

Nevertheless, they are the most widely recognized global guidelines for medical and surgical transition treatment and eligibility. Although the current sixth version of the SOC is footnoted on the HRC site,[2] the criterion itself does not specify a particular version.
This is beneficial in accommodating upcoming revision to the Standards of Care without invalidating the CEI criterion.

The second item notes that tying treatment coverage to the WPATH SOC would play a role in mitigating "medically necessary" and "cosmetic" exclusions in health benefit policies. This is an important point, because hormonal and surgical transition treatments are often falsely stereotyped as "cosmetic," "experimental" or "elective" by employers and excluded on that basis. In fact, the current SOC unequivocally affirm the medical necessity and efficacy of these procedures:

... sex reassignment surgery, along with hormone therapy and real-life experience, is a treatment that has proven to be effective. Such a therapeutic regimen, when prescribed or recommended by qualified practitioners, is medically indicated and medically necessary. Sex reassignment is not "experimental," "investigational," "elective,"
"cosmetic," or optional in any meaningful sense. [5]

As Samir Luther noted in his post, the American Medical Association has also asserted the medical necessity of transition procedures, stating that health experts have "rejected the myth that such

treatments are 'cosmetic' or 'experimental' and have recognized that these treatments can provide safe and effective treatment for a serious health condition."[6]

Luther also noted another positive development in the present 2009 CEI survey. Employers who claimed to provide coverage for transition health benefits were required to provide documentation.

While there is room for better clarity, I feel that the proposed changes in CEI 3.0 would bring significant improvement to a process that has marginalized trans health care in the past. I especially thank Meghan Stabler of the HRC Business Council, Dr. Dana Beyer of the Board of Governors, and former Business Council members Jamison Green, Donna Rose and Diego Sanchez, for their long efforts to advocate trans health benefit equity in the CEI.

The Really Bad News.

In my view, the greatest problem with the announced CEI criteria is years of delay before their implementation. While Mr. Luther stated that the new criteria "will be effective beginning June 2011,"[1] an HRC document explains that "The new criteria will go into effect for the Corporate Equality Index 2012 Survey and Report issued in calendar year 2011."[7]

A time-line in this document further clarifies that,

Because benefits typically operate on an annual cycle, all benefits changes must be effective by Jan. 1, 2012.

June 30, 2011 is listed as the deadline for surveys to be submitted to the HRC; and participants are given another month, until July 29, 2011, to "demonstrate that all new non-benefits criteria have been met and that all new benefits criteria will be met by Jan. 1, 2012."

Therefore, employers receiving a perfect 100% score on the HRC Corporate Equality Index may continue to exclude health care benefits for medical and surgical transition care, as well as non-transition care for trans individuals with atypical physiology, until January 1, 2012. Until then, exclusion of potentially lifesaving access to hormonal and surgical care is not only endorsed by the HRC for nearly three more years, it is held as a model of perfection -- of the very "Best Places to Work,"[8] for GLB and Trans employees. This is a travesty.

As Monica Helms, co-founder of the Transgender American Veterans Association, commented on the Bilerico Project last week,

...in the meantime, my 100% company will continue to deny me a medically-necessary procedure that would reduce my chances of breast cancer, bone density loss, heart attack and stroke. This is a procedure that others with the same body parts can get with far less proof [than] I need."[3]

Gender transcendent people, transitioning and post-transition individuals in particular, deserve better than this. As Mr. Luther himself commented, "No one should have medically necessary treatment denied."[1]

The HRC has defended its delay in requiring trans health benefit coverage to the 2012 CEI Survey, stating,

Because benefits plans typically change only once per year, because many employers currently work with insurance providers that do not provide inclusive insurance to any of their employers, and because the CEI must be achievable in order to motivate employers to participate in the first place, these changes will not be required until June 2011, when the 2012 Corporate Equality Index Survey is due.[9]

However, based on my experience of thirty years in the corporate world, as an employee, a manager, a consultant, and a policy advocate, I disagree. There is an old saying in the business world that I first learned from the co-founder of my own employer, Dave Packard:

What gets measured, gets done.

By excluding the measure of health benefits for transition procedures from the Corporate Equalty Index, the HRC has rewarded discriminatory policies and enabled further delay in equity for far too many years. In the current 2009 CEI Survey, the HRC passed out 193 perfect 100% awards to corporations that specifically excluded surgical transition procedures from coverage.[3] In my view, these scores were fraudulent and should have never been awarded in the first place. These corporations had already enacted equal opportunity (EEO) policies inclusive of gender identity or expression. Their executives were already aware that their health benefits exclusions violated their own EEO policies.

There is little doubt that it was "achievable" for these 100% CEI employers to enact inclusive trans health benefits before now. The HRC simply removed any motivation for them to do so. For exemplary employers, such as Cisco, IBM and Wells Fargo who genuinely earned their 100% scores by providing transition benefits coverage, the HRC offered no recognition in the CEI score.

Corrective Action Now.

I suggest that the HRC's commitments to its survey participants/corporate donors are subordinate to its commitment to LGBT equality, especially when the lives and health of human beings are at stake.

The HRC is correct in measuring a distinction between companies who fail to cover transition treatments/procedures but do not specifically exclude them, and those who specifically target these treatments/procedures for for exclusion. The latter pose a more urgent problem. These exclusions not only preclude any consideration on a case-by-case basis, they are often so broadly worded that they exclude ordinary medical care for post-transition people or individuals with atypical anatomy.

I believe that the practice of awarding 100% scores to companies with trans-targeted health benefit exclusions is unconscionable and always has been. I ask that the HRC, starting today, never again award a fraudulent 100% CEI score to an employer with policies that specifically exclude coverage for hormonal or surgical transition care.

For the 2010 CEI, I suggest that one point be subtracted for benefits policies that exclude hormone treatment and another for the exclusion of surgeries. This would apply to policies effective January 1, 2010 and would have a very minimal impact on scoring.

An award of 98 or 99% to corporations with discriminatory trans health benefit exclusions would send a modest message that trans lives matter. It would provide at least some incentive for change and provide an incremental transition to the more comprehensive CEI 3.0 criteria. Surely the health and lives of transitioning employees and dependents are worth one or two meager points on the Corporate Equality Index scale until the new 3.0 criteria are enacted.

To this old Irish engineer, an equal sign means equal; no excuses.



[1] S. Luther, "HRC: Corporate Equality 3.0," The Bilerico Project, March 3, 2009, http://www.bilerico.com/2009/03/hrc_corporate_equality_30.php

[2] Corporate Equality Index: Criteria 3.0 - Health Insurance for Transgender Employees and Dependents, http://www.hrc.org/issues/workplace/benefits/12207.htm

[3] K. Winters, "HRC Throws Trans Health Equity Under the Bus - Again, " The Bilerico Project, Feb 15, 2009, http://www.bilerico.com/2009/02/hrc_throws_trans_health_equity_under_the.php

[4] World Profession Association for Transgender Health (formerly the Harry Benjamin International Gender Dysphoria Association), "Standards Of Care For Gender Identity Disorders, Sixth Version," http://wpath.org/Documents2/socv6.pdf

[5] WPATH SOC v.6, p. 18.

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

[7] Human Rights Campaign Foundation, "Corporate Equality Index 3.0: Understanding the New Criteria," 2009, http://www.hrc.org/documents/HRC_Foundation_-_CEI_3_0_Criteria_-_2009.pdf

    The same time-line schedule for the CEI3.0 survey criteria is repeated at:

    Human Rights Campaign Foundation, "Corporate Equality Index: Rating Criteria 3.0 (2011-)," 2009, http://www.hrc.org/issues/workplace/cei_criteria_new.html

    Both clarify that the 2012 survey, taken between March and June 2011, will require that employment benefit policies are compliant with the 3.0 survey criteria effective January 1, 2012, rather than at the time the survey is taken in 2011.

    I have asked the HRC for confirmation of the accuracy of this time-line, published twice on the HRC web site. As of 03-09-2009, I have not yet received a response.

    Here are some important excerpts from the CEI 3.0 time-line:

    2011

    • Mar.31: 2012 CEI Survey released to participants (includes clearly marked questions that will count toward the new criteria only).
    • Participants will receive preliminary rating evaluations using new criteria only.
    • Jun. 30: 2012 CEI Survey must be submitted to HRC Foundation by the end of June.
    • Jul. 29: Participants must demonstrate that all new non-benefits criteria have been met and that all new benefits criteria will be met by Jan. 1, 2012.
    • Sep. 1: 2012 CEI Report released to public with new criteria only.

    2012

    • Jan. 1: Because benefits typically operate on an annual cycle, all benefits changes must be effective by Jan. 1, 2012.

[8] Human Rights Campaign Foundation, "Best Places to Work 2009," http://www.hrc.org/issues/workplace/11832.htm

[9] Human Rights Campaign Foundation, "How are transgender-inclusive benefits included in the Corporate Equality Index?" 2009, http://www.hrc.org/issues/workplace/benefits/12215.htm


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Hi Kelley: I have to disagree with you on this one. The CEI has an established policy to provide corporations with at least a year's notice before making changes. That means that the earliest they can be introduced for scoring is 2 years from now - in 2011. That's actually when they'll be scored. For example, the CEI that they released in September 2008 is actually titled "CEI 09".

I think it's also critical to approach this with a pragmatic eye. We're talking about fundamental changes not only in corporate benefits but also a significant change within the insurance industry itself. Neither of these things changes very quickly and I'd argue that the key here isn't speed, but the time to do the work to do it right. We've all got a lot of work to do between now and then.

There's a fine line between raising the bar to establish a new standard and setting it too high for companies to realistically reach. While I appreciate the need for all of this sooner rather than later I can't find fault in HRC, the Business Council, or the CEI itself for how they're approaching this.

I am not certain, Donna, that the HRC's policy will be of much comfort to individuals who are discriminated against by companies getting a "100%" rating from the HRC because individuals who are not being kicked while down decided that treating certain groups equally was setting the bar too high.

So, trans people, we don't offend the companies; just hang in there til 2012-I am sure that we Lesbians and Gays will get back to you, but we don't want offend corporate sponsors.....

Thanks so much for commenting, Donna. The HRC also has an established policy of “Working for Lesbian, Gay, Bisexual and Transgender Equal Rights.” It's pasted across the top of their home page at www.hrc.org. The current CEI policy rewards companies who not only omit coverage for medically necessary transition but explicitly single out trans and anatomically atypical individuals for exclusion. These exclusions extend far beyond hormonal and surgical transition; for example: "All expenses related to gender reassignment, including those related to complications arising from such services,"
and "not appropriate based on the gender of the patient." These exclusions can bar access to ordinary medical care for conditions covered for all other employees and dependents, including potentially lifesaving treatment. These exclusions are not “equal;” they embody intolerance and disregard for human dignity and even human life.

I am suggesting that these trans-targeted health care exclusions are so egregious, so hurtful, that this issue cannot wait until the entire CEI3.0 criteria are implemented in a future year. I am suggesting that the Human Rights Campaign close the loophole for these unconscionable health care exclusions now, in the 2010 CEI.

Kelly,
Thank you for reemphasizing this issue. I recently sent an internal E-mail to all the officers and sponsors involved with the LGbt Affinity Group and pointed out this new CEI, emphasizing that they need to push for these new requirements for our 2010 medical benefits so they will be well in place come 2011 (2012.)

Last year at this time, they turned their backs on me and ignored my request for help when the insurance company and our company denied my medically necessary procedure.

I decided to take a different approach to getting these benefits in place. I will appeal to the ego of gays and lesbians in the group, pointing out that keeping their "Precious" (the One Ring) 100%, then need to act and get our company to make the necessary changes. As long as the company did the minimum to get 100%, they didn't care about anything else. I was not getting proper medical treatment, but tough shit. They got their "Precious."

If anyone asks, I will tell them that if they want to keep the 100%, then they have to work for it. I'm not lifting a finger for it. They turned their backs on me, so I see this as karma. I have a saying I will be throwing at them all year, until the 2010 benefits are created in August/Sept. "100% or 75%? It's your choice." Personally, I can care less if we get 100% or not. It's never done me any good so far.

Daryl Herrschaft | March 10, 2009 1:35 PM

Kelley:

I appreciate you sharing your new post on the CEI now that the criteria have been released. We agree that the substance of the changes represent substantial forward progress. On behalf of the Business Council and the HRC staff that solicit and institutionalize their counsel, it’s nice to be recognized.

The CEI 2009 report is already measuring companies that have made some strides toward these new criteria (http://www.hrc.org/issues/workplace/benefits/7644.htm). It highlights 49 businesses that have insurance plans in which most medically necessary treatments would be covered. The list was based on our review of plan documents and other materials from nearly 100 businesses. The report contains a two-page section on our policy review and highlights the specific companies that passed the threshold. With the announcement of the new criteria we expect this section of the report to garner even more attention until the new scoring scheme take effect.

We employ these “screens” or overlays on the current list of 100 percenters to call out high achievers and point other companies in that direction, rather than arbitrarily reducing a company’s score by a point or two. The reason is that most businesses will base their participation in HRC’s CEI – a quite voluntary endeavor, which nonetheless has led to a sea change in LGBT inclusion in the corporate workplace – on HRC’s adherence to some guiding principles its administration. Among them, we won’t change the rules of scoring at halftime. If we lose their confidence in our system, we lose the chance to change things.

That being said, the CEI score is only one – and often a quite small – example of the ways in which we communicate with the CEI participants. While touting their scores in advertising and recruitment is important to companies, they also here from HRC through countless webinars, conference calls, individual discussions, on-site meetings, emails, newsletters and conferences that point them toward new policies and practices. If they miss all of those opportunities, they only have to pick up the report itself where the history of CEI and its future criteria are apparent.

Daryl

Daryl,
The requirements are good, but you should have initiated it 3 to 4 years ago when Donna and Jamison brough it up to you. Last year, as Kelly pointed out, I was denied a medically necessary procedure because my company was not about to go above the minimum requirements for the 100%. They do the lest they can do to please the gays and lesbians in the company, and thise gays and lesbians can care less about my needs.

Last week, I had what appeared to be a heart attack, because I was feeling weak and I had a sharp pain in my left arm. It wasn't, but it had all the earmarks of one. I've been taking high doses of estrogene for 12 years now and if anyone has been keeping up with the news, that can cause a lot of problems with a body. One of the problem is heart attacks. You think I wasn't thinking about HRC's crappy CEI when I was at the doctor's office. The proceedure I need is one that would allow me to cut down my dosages.

So you see, I can easily blame HRC's weak CEI for any future medical problems that are directly affected by high doses of estrogene. To keep the gays and lesbians from whining, our company would do only what it needs to to placate their delicate sensibilities. If the CEI doesn't require they to provide me with good medical help, then I won't get it. Get it? 2012 Is a cop-out, nothing more then to give HRC bragging rights to say, "We care about transgender people." BS! You only care about image.

Everyday Transperson | March 10, 2009 3:46 PM

Well, Well, Well......... I knew it wouldn't take long before HRC's devout supporters and staff gathered together to comment on an article which is calling HRC on its apparently unfair and fraudulent reporting of corporations via the CEI index............

The only reason why this person's argument appeared to be addressed here by the HRC "people" above (which by the way has been raised many times and years before by employees........funny how they never get "invited" to write an article about the subject or were responded to......) was obviously due to the fact that a 30 year "corporate" veteran and "consultant" was the one who raised the issue........


The ONLY voices that HRC and their crony "activists/consultants" appear to hear and listen to are those of corporate and political people !!! And why shouldn't they really ??? After all, those are the ones who bring in the corporate "sponsors" and who are responsible for getting HRC media coverage, so it is a win/win for THEM..... The rest of the everyday GLBT community who is bearing the brunt of your little corrupt "system" is quickly and effectively censored and silenced and kept out of the loop if they raise voices to protest against this, isn't that true Ms. Rose and Mr. Herrschaft ???

To Dr. Winters who wrote:

"I especially thank Meghan Stabler of the HRC Business Council, Dr. Dana Beyer of the Board of Governors, and former Business Council members Jamison Green, Donna Rose and Diego Sanchez, for their long efforts to advocate trans health benefit equity in the CEI."

Well, aren't all these people you thanked linked to the corporate / political arm of HRC in some form or fashion ??? So in one breath you denounce HRC for the index inequities, yet in the other, you kiss the asses of many of those people who were apparently responsible for the corruption in the first place !! Sounds awfully hypocritical to me...........

And Mr Herrschaft, a very profound explanation of your "system" at HRC:

"The reason is that most businesses will base their participation in HRC’s CEI – a quite voluntary endeavor, which nonetheless has led to a sea change in LGBT inclusion in the corporate workplace – on HRC’s adherence to some guiding principles its administration. Among them, we won’t change the rules of scoring at halftime. If we lose their confidence in our system, we lose the chance to change things."

This could be furthest from the truth !!! You know very well that corporations seek out HRC and their index scores because HRC has an ENORMOUS amount of political clout, access to politicians and lobbyists, many corporate executives in their back pocket and most importantly INFLUENCE with the GLBT media. So naturally they will fight hard to kiss HRC's ass by way of corporate lobby money.....oops corporate "sponsorships" (we have to be politically correct here don't we ??), corporate perks to its staff and its associated "activists", and complementary freebies which allow you all to continue this "activism" work. So, Mr. Herrschaft as you said:

"If we lose their confidence in our system, we lose the chance to change things."

Don't you really mean, if we lose their corporate funding then we have no incentive to help them "achieve" a 100% each year ??? Corrupt politics at its best !!

And lastly, Ms. Rose, you so clearly stated:

"We've all got a lot of work to do between now and then."

Well who exactly is "we" ???? Because the only "we" I have been seeing over the past few years "working" on these issues (and very unsuccessfully I might add) are you and that same old self- proclaimed "activist" corporate/political clique who have decided to stick their noses into things which they are not clearly NOT qualified to undertake !!! Tell everyone here what happens to everyday employees who challenge the "activist" status quo and the price they pay for threatening your "power" and "glory" with ideas and actions which might actually get something done !!! Your past corporate "best practices" model didn't work and it still doesn't work for the greater community, Yet it works nicely for you all..................

So, to all of the people mentioned above in this comment I say you are kidding no one...........You speak a good game of "inclusiveness", "accountability" and "equal rights" for our community, yet how hypocritical when you discriminate and exclude (and in some cases even ruin) those everyday GLBT people in the community who are not in your "esteemed" corporate/political circle.

PUT YOUR MONEY WHERE YOUR MOUTHS ARE AND START PRACTICING WHAT YOU PREACH YOURSELVES !!!

Time for new "leadership" !!! Individuals who won't engage in such corruption for self gain, but will look on the best interest of the community and ALL in it, not solely for who is in the corporate/political palm greasing clique !!

Thank you for your time.

Slow, slow, slow, slow. I agree these changes could have come much faster, especially if they were included in CEI 2.0. There weren't any less egregious back then.