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 Obama'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:
- 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
- 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