Best-in-class employee benefits evolve with the times and our changing values. We saw marriage equality granted to all people in this country after Obergefell v. Hodges, opening employee benefits to many additional spouses and families. Now, we’re seeing more and more employers (including Fortune 100 and 500 companies) embrace transgender-inclusive health insurance plans as gender identity awareness improves. However, medical professionals have been stressing the importance of transgender health for years.
In 2008, the American Medical Association (AMA) first voiced its concerns for the discrimination of transgender individuals when it published a guidance supporting “public and private health insurance coverage for treatment of gender dysphoria as recommended by the patient's physician.” (This policy was updated in 2016).
In order to truly be an equal opportunity employer, you should have at least one transgender-inclusive health insurance plan in your employee benefits package. It’s not as complicated or expensive as it may sound. In fact, right here in our home state of Arizona, there are quite a few employers already offering such benefits.
Here are some practical issues you should consider when expanding your employee benefits to make sure they include transgender employees and how doing so could help you recruit and retain the workforce of the future — namely, millennials and generation Z, who see inclusivity as an important attribute of prospective employers.
The Affordable Care Act (ACA), otherwise known as Obamacare, protects transgender individuals from discrimination by insurance companies — assuming the insurance company receives federal aid. Of course, most insurers receive some sort of federal dollars, but certainly not all, so if you choose to provide transgender-inclusive health insurance for your employees and your insurance company pushes back, be sure to check on their federal aid status (your employee benefits broker should be able to help you with this).
However, there are very few laws on the books that protect transgender individuals in the workplace, which is why the onus is on employers to provide accessible healthcare. At this point, there is no federal law on the matter, so you’ll need to check with your local municipality and state to see if there are any requirements you need to follow. As with most laws, change is starting at a grassroots level and will move upward from there, so it’s possible your local city passed ordinances you’re unaware of just yet.
One of the myths surrounding the decision to provide coverage for transgender employees is that it costs too much. Because transgender individuals are still seeking acceptance, the data available for the cost associated with insuring them is limited. But the Human Rights Campaign (HRC) commissioned a study of the city and county of San Francisco between 2001 and 2006 to start the process.
The study found that “The cost of services per employee per year was minimal, with costs per insured per year averaging between $0.77 and $0.96: less than a dollar per year per enrollee. [...] Thus the average dollars per claimant per year ranged between $3,194 and $12,771.” For reference, the average per capita cost of medical care for a person with diabetes in 2002 was $13,243.
One could argue the estimated cost per transgender employee is no more than any other employee could claim in any given year, depending on the level of care needed. Of course, transgender persons aren’t exempt from chronic diseases, cancers, and mental health problems, and some say they’re even more vulnerable to such health concerns. But even if your transgender employee(s) were to have a chronic condition, it’s unlikely that your transgender population alone would cost you as much as the rest of your workforce because of sheer numbers.
One of the most significant reasons why transgender employees don’t cause most company’s rates to rise in any significant manner is because there simply aren’t that many transgender individuals in the population. According to Psychology Today, “Among individuals who are assigned male gender at birth, approximately 0.005 percent to 0.014 percent are diagnosed with gender dysphoria. Among individuals who are assigned female gender at birth, approximately 0.002 percent to 0.003 percent are diagnosed with gender dysphoria.” (However, these numbers may be slightly deflated because they only include persons who seek treatment, ranging from hormone therapy to surgery.)
In addition, not every transgender person will receive every possible treatment. Some may only want to do hormone therapy without undergoing surgery, while others will want to do partial surgery with hormone therapy, and others will want all of the above.
The Case for a Transgender Employee Inclusion Clause
Businesses large and small are adopting transgender-inclusive employee benefits, although larger businesses appear to be leading the charge. Companies like ADP, Boeing, Best Buy, Coca-Cola, Ernst & Young, GameStop, Goodyear Tire & Rubber, Hyundai, Home Depot, Lowe’s, Progressive Insurance, Royal Caribbean, Visa, and multiple airlines have joined the ranks of employers who’ve chosen to provide explicitly inclusive benefits for transgender employees.
According to data from the Corporate Equality Index managed by HRC, in 2012, 56 percent of Fortune 100 companies offered at least one transgender-inclusive health insurance option, as well as 140 of the Fortune 500 (28 percent), 165 of the Fortune 1000 (17 percent), and 81 of the AmLaw 200 (41%). That’s up from just one company in each of those categories in 2004.
This also includes companies based (or with major hubs) in Arizona, such as Intel, American Airlines, Univision, Avnet, Republic Services, Petsmart, Insight Enterprises, and Pinnacle West Capital. Because all of these companies could be competing for the same talent pool as your company, it’s important you’re aware of their benefits offerings. If you’re looking to keep your employee benefits package competitive, adding a transgender-inclusive clause to your health insurance may be a way to recruit and retain the best and brightest candidates.
Inclusive, Affirmative Policies
According to Beck Bailey, Deputy Director of Workplace Equality Programs at HRC, the organization used to receive reports of denials for claims completely unrelated to a person’s transgender status (such as a broken arm) simply because the person was transgender.
And while they aren’t seeing as many reports like this as of late, the language in insurance policies is still very broad, leaving transgender employees vulnerable to discriminatory practices. Even though there’s no explicit exclusion, there’s also no confirmation that the claims should be covered.
For this reason, having a specific affirmation clause is considered a best practice. If you want to ensure your transgender employees receive the medical attention they need regardless of the reason, it’s important to communicate to the insurance company that you want their claims to be approved.
Companies including an affirmative transgender-inclusive clause in their insurance policies are both fully funded and self-funded, but for small businesses, they may not have such custom options available to them. Therefore, some small to mid-size businesses choose to self-fund certain sections of their health coverage, such as trans benefits, fertility treatments, and autism support.
This practice picked up steam with fertility and autism support over the past decade, as more people shared their experiences and the country as a whole became more aware of these issues. Advances in modern medicine made couples struggling with fertility more likely to conceive, and with as many as 1 in 59 children on the autism spectrum, many companies have employees who are struggling to find adequate care for their children.
Choosing to include transgender employee benefits in this practice has been a no-brainer for many smaller businesses, who find this method allows them to provide more robust benefits to their workforce than typical stock and trade plans available to them.
Care is Necessary, Safe, and Effective
Like any other health concern, transgender employees seeking treatment will begin with a conversation with their doctor. This is how the doctor will determine if a diagnosis of gender dysphoria is appropriate, at which point, the doctor can develop a custom treatment plan based on the needs and wishes of the patient.
The treatment developed for gender dysphoria is no longer experimental, and has been proven time and time again to be necessary, safe, and effective. Bailey believes it’s a rather simple matter, actually: “If the purpose of providing benefits for your workforce is to have a healthy, productive workforce, then you want transgender people who have access to trans care.”
How to Learn More
Offering transgender-inclusive employee benefits is one of the best ways to ensure your business is an equal opportunity employer, in addition to attracting and retaining the best in the talent pool available to you.
Remember that there could be state or local laws specific to your geographic region, so be sure to check with your legal counsel when you’re working on your employee benefits package. If you’re interested in learning more about transgender benefits, HRC has a wealth of information available, as well as a toolkit.
The JP Griffin Group is proud to be a long-term member of One Community, a coalition of socially responsible Arizona businesses and individuals who support the LGBT community, diversity, inclusion and equality.
Are you looking to expand your health coverage to include transgender employees? Leave us a comment below or contact us. We’d love to help you create an inclusive employee benefits package!