Guest Blogger

HRC: Corporate Equality Index changes for better transgender health care

Filed By Guest Blogger | October 07, 2010 2:00 PM | comments

Filed in: Living, The Movement, Transgender & Intersex
Tags: Corporate Equality Index, HRC, Human Rights Campaign, Meghan Stabler, transgender health

Editors' note: Meghan Stabler is a nationally recognized spokesperson and activist for the lesbian, gay, bisexual and transgender community. She also served on Senator and then President-Elect Meghan_SFO_Gala.jpgObama's LGBT Policy Committee.

There are many issues with regards to adequate access and coverage to healthcare for the LGBT community. But this is exacerbated for transgender individuals. Transgender people are often categorically denied health insurance coverage for medically necessary treatment, irrespective of whether treatment is related to sex affirmation/reassignment. Up until the last few years, nearly all U.S. employer-based health insurance plans contained "transgender exclusions" that limited insurance coverage for transition-related treatment and other care. For any employee, the denial of coverage for medically necessary services and treatments can be both traumatic and life-threatening.

As a member of HRC Board of Directors and since 2008 a member of the HRC's Business Council I, along with other members of the business council who are external business leaders provide expert advice and counsel on LGBT workplace issues. We made it our goal to ensure that we focus on uplifting the requirements for transgender inclusion and provide HR, diversity and benefit administrators with a clear path to remove transgender exclusions and ensure the provision of health insurance. The HRC's Corporate Equality Index (CEI) annually rates corporations on their LGBT workplace policies and benefits. The latest CEI (3.0) now provides the motivation for employers to work with their insurance carriers or administrators to remove transgender exclusions and provide comprehensive transgender-inclusive insurance coverage.

This new CEI criteria significantly raises the transgender health requirements for employees and their dependents. It applies to business operations throughout the United States, including wholly-owned subsidiaries.

My friend Joanne Herman wrote a recent article in the Huffington Post titled the "Sorry State of Transgender Healthcare" that concisely detailed many of the issues facing our community. Transgender healthcare coverage and benefits have for too long been excluded from many corporations' healthcare plans. It has been a systematic level of discrimination against transgender employees that has a devastating impact on so many people, that needs to change. And it will.

As part of HRC's commitment to ending transgender discrimination full credit will only be given to employers offering all benefits-eligible employees (and their dependents) at least one health insurance plan that

  • Covers medically necessary treatments without exclusions or limitations specific to transgender individuals or to transition-related care, and
  • Conforms to current medical standards of care such as those defined by the World Professional Association for Transgender Health's Standards of Care in determining eligibility and treatment coverage for transition-related services.

This means that an employer must provide at least one plan that is available to all their employees that provides for complete transgender coverage, from therapy, to hormones/blockers, to medically necessary surgical procedures and aftercare etc. This plan must also include dependents of the employee so that a transitioning 'dependent', including a child, is covered. These effectively eliminate discrimination against transgender employees and/or dependents. Many businesses have already taken steps to remove discrimination from at least one of their health insurance plans for employees and their dependents: Employers of varying size and across industry sectors have successfully introduced coverage inclusive of services related to transgender transition, either at no cost or at a negligible cost.

We have also recognized that when employers place financial caps upon the coverage they are once again represent insurmountable barriers to care and in many cases were so small that available options to the transitioning individual were limited, thus placing yet another financial burden on the employee. These caps are discriminatory and in the CEI we will ask that they at least are a minimum of $75,000 or greater and preferably be removed entirely.

Another employer false fear is that the cost of coverage would be astronomical. In-depth interviews with a subset of employers indicated that there had been little or no initial increase in premiums, that both absolute and annual per employee costs attributed to benefit utilization had been minimal, and that there had been no impact on subsequent premiums.

I truly believe that the latest uplift to the CEI, and the requirement to provide transgender services in order to achieve 100%, signals a pivotal moment of inclusionary change for both the employer and transitioning individual.

For more information visit www.hrc.org/cei

Summary overview of equal health coverage for transgender individuals in the calendar 2011 CEI:

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
  • Coverage of routine, chronic, or urgent non-transition services (e.g., for a transgender individual based on their sex or gender. For example, prostate exams for women with a transgender history and pelvic/gynecological exams for men with a transgender history must be covered)
  • Existing plan features should extend equally to transition related care, e.g., provisions for "adequacy of network, "access to specialists, travel or expense reimbursement
  • Dollar caps on this area of coverage must meet or exceed $75,000 per individual

Full Criteria

  • Coverage available for full range of services indicated by World Professional Association for Transgender Health's (WPATH) Standards of Care, including the Medical Necessity Clarification Statement
  • No Lifetime or Annual Dollar caps on this area of coverage
  • Benefit administration covers treatment plans that adhere to the WPATH diagnostic and assessment process.
  • Eliminates barriers to coverage:
    • No separate dollar maximums or deductibles
    • Explicit adequacy of network provisions
    • No other serious limitations

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All the companies claiming to have 100% compliance are going to go down to a trickle. Which is good, because the other CEI was a joke and so unrelated to the needs of trans people that it was virtually useless. Moreover, I would like to see a study of discrimination complaints made against companies claiming prior "perfect" scores. I know of at least one 100% firm which has discriminated against several trans employees yet puts out a press release every year touting it's perfect score.

I would also like to see studies of governmental institutions like city government employees. There is a lot of chest pounding and pr going on in the foreground and a lot of tacit discrimination continuing in the shadows.

Meghan Stabler Meghan Stabler | October 7, 2010 7:24 PM

Gina, you are correct in so much as the prior versions of the CEI ( prior to the 3.0 criterion ) would allow the easiest of ways for a company to claim a 'benefit' for trans employees - simplest being shortterm leave! So, with the 3.0 criteria this is a more stringent test, and the CEI requires proof of trans coverage and trans exclusion removal from a plan. This is good, along with all the other things that I listed in my post. No longer can a company attain 100% and not provide coverage. In addition, should someone report that 'practice' is not in line with 'policy', let us know so that we can address it with that 100% company. As you mentioned more companies may drop below 100%, but equally many of these companies are currently working hard to ensure they will regain 100% through adopting the new criteria too.

I'll believe that when i see it.

Gina,
I work for a company who does the same thing. It brags on the company website when it gets its 100%, but won't even cover something as simple as an orkie.

Meghan Stabler Meghan Stabler | October 7, 2010 7:33 PM

Monica, The prior CEI enabled a company through a lose set of criteria options, that looseness is no longer available and if you read through my most, and maybe the full criteria at www.hrc.org/cei you will see that there are no more options, this IS FULL inclusion via a plan for trans employees and dependents, with therapy, hormones/blockers, medically necessary surgeries (defined by WPATH) and other items. No options, no opt outs, no failures to provide. So the new criteria for 3.0 is significant and employers must provide proof, if there are discrepancies then let us know, let me know and I will address them, if they then fail to - the points will be deducted and they will not be 100%. Monica, this is a significant change, whilst your employer may have limited things before they can't now, unless there are issues around union plans. But lets talk about that.

I know you've been working on this for some time.

I only wish the political wing of the HRC had been 1/100 as effective as you've been here.

My applause on this, it's a far bigger deal than it looks at first sight.

Meghan, we maybe talking sooner than you think. November is the month where we select our 2011 medical benefits. I'll know then when they send out the packet later this month.

YAY! My corporation has worked hard to get from 80 to 100! It’s not easy at all or gratuitous. I do wish the CEI had a block for a corp/company to have a Pride organization within it, have it visible and accessible for job seekers to inquire with them for the actual work climate. As for insurance inclusion, I've read a lot of insurance policies and honestly most of them simply do not ‘fill the bill’. It’s one thing to have a policy but having a policy that has so many restrictions on its use that make it unusable isn’t worth having. [but, I'm not stopping or giving up, I've started talking to my company POC's trying to figure out 'how' we can offer a smart SRS benifit that is acceptable by all and usable by those who need it and for what they need it for.]

Meghan Stabler Meghan Stabler | October 7, 2010 11:11 PM

@Gina, I am sorry that you experienced that. There are currently at least 11 Healthcare Plan providers that have policy coverage options for trans individuals available. The cost for coverage is absolutely negligible and we find that once a company sees that the overall cost to include a plan is so small, the process is started. The new CEI (3.0) along with all the background materials that the HRC Workplace team have available for companies to use in working with plan administrators is very useful and well tested.

This is very good news, but I still think more is needed. I've been actively discriminated against by at least two companies that bragged of 100% CEI scores. It wasn't about the insurance although neither would score 100% on the new criteria, it was direct ground-level discrimination and when I challenged it I was quickly fired.

I'd like to see the CEI factor in these kinds of experiences into its ratings. I know that each and every complaint can't be considered valid out of hand, but at the same time, a company that is the subject of many similar complaints of this nature can and should be investigated and points withdrawn if they are found not to measure up.

Rating corporate policies and benefits is great and in my opinion is one of the most useful things HRC does, but without these companies being held to account for how they treat LGBT employees on a day-to-day basis in their actual workplaces I don't see how it can be a credible rating, particularly for prospective LGBT employees looking for a supportive company to work for.

Meghan Stabler Meghan Stabler | October 7, 2010 11:07 PM

@Rebecca, Let me reitterate that the prior CEI (2.0) lacked coverage, complete coverage and thus when a company scored 100 it truly, via 1 of 5 options, could claim they were progressing trans issues. The 3.0 that I have out lined, stops that, it broadens the requirements, and removes the transgender discrimination; from exclusionary language to providing at least one plan that covers everything.

While many here reflect on the past, and rightly so, let's also look to the future. The process of completing the survey and submitting it, is only one part, the other is supplying proof of coverage and the removal of the discriminative exclusions. Should, we find that what was submitted is not correct, and when brought to correct that, then points will be deducted.

Having worked with so many corporations over the last 18 months on this, I, along with the HRC workplace staff, have first hand see how company HR officials are working to ensure that have all the much needed policies in place.

I understand your point Meghan, I'm just saying that without a component that directly addresses the day-to-day treatment of LGBT employees in their actual workplaces, I don't feel that the CEI offers much to those of us looking for a supportive company to work for. Even worse, it provides cover for companies, like some I've worked for, that take great pains to have policies that get them a 100% rating but don't implement or adhere to them in the actual workplace.

Of what value really is transgender insurance coverage when your everyday working life is made a living hell due to discrimination on the job? Similarly, of what value is the a CEI rating based on supportive policies and insurance offerings when companies are not held to account for actually adhering to those policies?

Sadly, I think this is just another example of how HRC focuses on the reality experienced by the six-figure crowd, with little or no attention paid to what the rest of us experience in the real world.

As an example of what I'm talking about, when I first applied at Best Buy, I checked them out on the CEI and found they had a 100% rating. What I discovered when I actually worked there was that it was great for those who are "merely" gay or lesbian, but transgender workers like me were not allowed to work in positions requiring direct public in-person contact, nor were we seriously considered for promotion and raises regardless of skill or experience. They would hire us to be in compliance with state law (and help the company qualify for tax breaks by hiring minorities) but once hired there was no hope of upward progress nor of being treated the same as non-trans employees.

That's the problem the CEI still doesn't address and until it does I see it as a tool of very limited value for those of us looking for a good company to work for.

Angela Brightfeather | October 7, 2010 10:06 PM

Gina,

Congrads on this much needed change. It's nice to see that someone at HRC is paying attention when it makes common sense.
One Question....You noted that in order to get the 100%, a company must offer an insurance policy that covers the points that you made.

Is that policy offered with the same carrier that all other employees are covered by, or can that be a policy offered from a different insurance company that may require a higher employee share of the payments?

Many employee policies are partially paid by employee and employer.

I second this question. Employers and insurance brokers work well together and will quickly ramp up the already existing workaround. One of my former employers kept a policy in their back pocket to cover state-specific requirements not dissimilar to this. It fulfilled the technical requirements so that the company could claim compliance but the employee's portion was higher than if outside, non-group coverage had been purchased! My current employer does something similar, a special higher-employee-cost policy offered solely to meet an obligation. No employee has selected that particular coverage in the history it's been offered due to the incredibly high employee cost. It's a wonderful slight of hand trick, offering coverage that no one in their right mind would purchase.

Does the CEI 3 specifically require that the employee portion for full TS-coverage insurance be no higher than that of other employees?

Does it require Ts-coverage to be included in all policies offered by an employer?

Didn't think so. It only requires that one full coverage policy be offered. Practically telegraphs the politically correct workaround to HR.

I fear the new CEI 3 will encourage a set of Separate but Unequal coverages, hardly a step forward for the trans employee yet fabulously progressive seeming for the employer ...and HRC.

(also, "women with a transgender history" and "men with a transgender history"...Really? Can you blend the definitions any more in a single sentence? Does that include ex-drag kings, recovered cross-dressers and people that used to be gender fluid but later solidified? Exactly which surgeries are they seeking to have covered, please?)

Meghan, I think we're not just talking about health coverage (which is certainly crucial) we're talking about companies which have discriminated against trans employees yet on paper looked good.

Again, I'd like to see an expansion of such ratings to subjects like discrimination against freelancers and contractors. Fewer and fewer corporations and employers in the US are hiring 100% time, full benefit employees and more of the workforce is being employed as contractors... which totally gets around the HRC criteria (and many laws), allows companies to discriminate almost at will and never gets registered on such reports. A large number of transitioning people find themselves in such employment and they are in highly vulnerable situations even by companies which are supposedly progressive.

I think it's great that your tightening up the requirements for employers to include offering an inclusive medical insurance policy.Has anyone thought to compile a list of universities that offer this type of coverage to not only it's faculty but to students as well? I'm currently in college and getting ready to try to get my college to change it's discrimination policy to include gender identity.It is a community college so I don't think they offer coverage to students but I will ask them if their faculty has the option of receiving an inclusive insurance policy.I plan on transferring to a four year college and many of them either require or offer insurance to students. It would greatly influence my decision as to which four year I would go to if I knew that I could get such an insurance policy.

Meghan Stabler Meghan Stabler | October 10, 2010 2:20 PM

Amy,

You bring up a good point regarding the 'climate' for trans-students and availability of healthplans. I am aware of a number of colleges that do cover both therapy and hormones, but none that have surgical coverage. With the increasing amount of college dorms that are "gender neutral", and that have specific non-discrimination polices for SO/GI along with trans-welcoming and affirming programs, this could be an area to look in to.

Thank you for bringing this up.

Women of transsexual history is a term that was specifically and exclusively coined by those born transsexed who utterly reject and find insulting the term "transgender". For HRC to transpose this is further evidence that the A-Gay, Queer Inc crowd wishes to actually erase those born transsexed who are binary identified.

Par for the course for an organization with a long shameful history of buying off leadership, subverting grassroots organizing efforts and actually pre-lobbying against women of histories seeking their civil rights. Anyone working with HRC is a traitor or fool.

Some of us worked to expose HRC long ago and will never forget.

Now that the enemy is at the gate, tsunami at the ballot box in a month, etc. etc. NOW they want to play nice- when it doesn't cost them anything. Self-centered corporate "activism" at its best.

It all comes down to what you have been writing about for quite some time now. Your essays should be required reading for anyone who wants to be an activist in this area.

How many years has the HRC been around? How many trans women have been forced into sex work, lived in homeless shelters, delayed transition, self-medicated, died from "pumping", and committed suicide because they couldn't afford to transition, were excluded from coverage, or simply got fired?

This to little to late gesture from a group of professional political and corporate lap-dogs isn't cutting it. The simple fact is that the HRC's history of trans involvement is more antagonistic and appropriative than anything close to advocacy or even lukewarm ally-ship.

Forgive me if I don't join your (I'm sure extravagant) party. I'm sure this new CEI will be a huge boon... until it cuts into the donations for next year's clothing allowance.

I already know what loophole my company will use to still get their 100%. The requirement is that they have to provide trans inclusion in only ONE of the policies offered. I already know which policy that will be. They will have it in the Kaiser HMO, the most expensive and worse possible policy for a trans person, especially one who has been with the company for 2 decades and has been living their true life for over 13 years.

Here in Georgia, I found a great doctor who takes care of ALL of my medical needs, without having to go to anyone else for anything. In an HMO, I would have to give him up and take a chance that an in-system doctors would have any knowledge of trans medical issues, much less willing to see me at all.

I'm sure it's the same with other trans people in the company. Once a trans person finds a good doctor, they don't want to take a chance trying to find a new one, especially in bigoted Georgia. The corporate headquarters is in Kansas and they have a major facility in Virginia, so the trans people there will not have any better luck.

So, my company keeps their 100% while not doing anything special in helping their trans employees. Nothing will change. I guess I'll have to wait for CEI 4.0, if I live that long.

>> Conforms to current medical standards of care such as those defined by the World Professional Association for Transgender Health's Standards of Care in determining eligibility and treatment coverage for transition-related services.

Current as of when?

If they mean current as of February 2001, the SOCv6 from the prior HBIGDA association then that supports psychopathologisation. If they mean current as of the WPATH statement of policy May 26, 2010 that rejects psychopathologisation. Which makes all the difference in the world when it comes to a decision whether to claim for a mental illness needing psychotherapy or for a congenital malformation needing surgery. See http://www.wpath.org/publications_public_policy.cfm

That conflict will not be resolved until September 2011.

It appears that HRC did not discuss the matter with the WPATH Board of Directors before issuing this statement. Should anyone be surprised at such thoughtlessness from HRC?