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In this month's issue of Employee Benefit News:

Large companies push progressive benefits forward

By Lisa V. Gillespie

February 1, 2012

Thirty-three percent of major employers offer transgender-inclusive benefits. This is five times more companies than last year, and a big part of the push came from the Corporate Equality Index, a series of guidelines from the Human Rights Campaign that measured employers on five criteria regarding benefits for transgendered workers: short-term leave, counseling by a mental health professional, hormone therapy, medical visits to monitor hormone therapy and surgical procedures, without any exclusions.


Eliminating exclusions

The "without exclusions" part is significant, because for years, transgendered employees were denied medical benefits because they were in the process of transitioning or had previously undergone gender reassignment surgery. So, say a transgendered employee was injured in a fall, went to the emergency room and disclosed to the hospital he had undergone gender reassignment years before. Because of these "exclusions," the employee would be denied treatment because of language like, "Services for, or leading to, sex transformation surgery," or "Gender Transformation: treatment or surgery to change gender including any direct or indirect complications or aftereffects thereof." The same denials pertained to mental health services because of "Transsexual surgery including medical or psychological counseling and hormonal therapy in preparation for, or subsequent to, any such surgery."

"There was a lot of moral judgment of people changing their sex, but we have a much more nuanced experience with it now because more and more people have been talking about it rather than sweeping it under the rug," says Andre Wilson, a policy consultant and educator on gender issues for 20 years. On top of the basic medical care that was frequently denied, employers were also not paying for the sex reassignment surgery. The average cost for a male-to-female surgery is about $17,000, plus $1,000 for therapy, $1500 for hormones and $500 for doctors visits and lab tests. Though the cost for care is relatively the same if an individual or an insurance company picks up the tab, the cost to a plan is relatively small in comparison to the out-of-pocket cost to an individual.

Though no claims data has been made available by the private industry, one city has, and it has seen better results than originally anticipated. In 2001, the City of San Francisco made available transgender benefits, and their claims cost much less than they had anticipated. In 2004 and 2005, there had been 11 claims for surgery, totaling $183,000, or $46,000 per year, not including costs for therapy or hormones. The city lowered its charge to $10.20 per year-per employee - or 85 cents per month - raised its lifetime cap to $75,000, removed the one year employment requirement and offered the benefit on every health plan offered to its 30,000 employees.

"This is why we have insurance in the first place, to spread the risk of high-cost treatments across a pool of people, and that's true for everything," Wilson says. One of the main reasons health plans and self-insured employers didn't offer the benefits is because people simply didn't know.

Wilson explains it this way: "For executives, maybe they can afford it, so they don't ask for the changes in the policy because they don't want to make waves, and the low-wage workers don't want to ask because they don't want to make waves. They have a well-documented history of trying to fit in."


'Leveling the playing field'

Benefits aren't the only arena transgendered employees must grapple with: 97% of transgendered people surveyed by the National Center for Transgender Equality and the National Gay and Lesbian Task Force in 2009 reported experiencing harassment or mistreatment on the job, while 47% had experienced an adverse job outcome, such as being fired, not hired or denied a promotion. But with providing benefits, "you're essentially leveling the playing field," says Victoria Fulkerson, vice president of corporate relations and supplier diversity at the National Lesbian and Gay Chamber of Commerce. "You waste less time on how you're different and spend more time on how you can do your job."

The majority of the 636 companies cited by HRC are self-insured, but companies under group plans can also get coverage, although it is sometimes an "add-on" for an extra free. Aetna offers it as such, but would not specify how much it costs a company. Scot Roskelley, communications director for Mid-America region, also wouldn't say if they have plans to make it part of their basic medical coverage.

For self-insured plans, it's easier to offer because it assumes the risk. However, according to Deena Fidas, deputy director at HRC, most insurance companies have had guidelines around the coverage for a decade or more.

"Some companies will charge because they're still trying dissuade people from adding it because, I suspect secretly - and they wouldn't acknowledge it - they have a moral objection," Wilson says.

But just like depression, having gender identity disorder is diagnosed by doctors, and the American Medical Association asserts that when discriminatory financial barriers are placed between the transgender community and proper health care by dismissing treatments as "cosmetic" or "experimental" - even when covered for other patients with other recognized medical conditions - more expensive problems can develop as a result, such as depression, substance abuse problems and stress-related illness. And, Wilson says, those companies don't "understand how vital these services are."

Staples, a self-insured employer, offers two plans that went into effect Jan. 1. Craig Hazenfield, vice president of human resources at Staples, says a main reason they hadn't included the benefits in previous years was simple education.

"This is new territory for many companies. Making advances in this area requires understanding, education and, in some cases, exposure to transgender individuals," he says, relating it to domestic partner benfits. "More companies will recognize the value these benefits provide to valuable associates who just happen to be transgender."

The business case for offering the benefits appeals to a price tag that can run lower than some expensive surgeries, and to employee morale and productivity. "Our associates can't be expected to be at their best if they are burdened with something that prevents them from being who they are in the workplace or burdens them with medical expenses," Hazenfield says.

MGM Grand International is another employer who offers benefits, but it did not qualify under the Corporate Equality Index because it only offers prescription medication and counseling related to transgender care. Jeff Ellis, vice president of benefits, said that the company had been offering these for a little over five years, and that he envisions it will start offering additional benefits in the upcoming year.

Fields expects the number of companies they qualify as transgender-inclusive to increase again next year, because though the term "transgender" was taboo or simply unknown in the past, it is gaining recognition, along with the benefits that go with it.