HRC’s New Corporate Equality Index Requires Removal of Exclusions to Transgender Healthcare and Benefits

Posted: October 13, 2010 in Discrimination, DSM, GID, ICD-10, ICD-9, Insurance, medically necessary, pathologized, politics, Transgender

First and foremost before I even post this article I would like to touch on the fact that it seems like we, transgender men and women, have been put on the HRC back log until now. So we shall keep the faith and just see where this goes. If its truth this would be a campaign I’d like everyone to work on not just HRC. Seeing as though though this is a subject of life and death for youth, lower income, no income, and the list goes on. This would help to alleviate worrying about “will my job’s insurance cover my T?”, questions like that shouldn’t have to be contemplated it should be a known fact that XYZ company has XYZ insurance and there are no exclusions that boast one of the biggest discrminations there are. Not to mention if this works i could mean much competition in the insurance world, and if theres competition they will start to remove exclusion to keep up with the next. As most managaement teams also know and stick by, ‘A healthy employee, is a good employee’. This statement is sometimes by passed as only physically limited when in fact mental health is a very big part of it as well. But enough of me ranting here is the article.

By Anthony Moll
October 6th, 2010 at 3:16 pm

The following is from Meghan Stabler; Meghan sits on HRC’s Board of Directors and Business Council:

Transgender healthcare coverage and benefits have for too long been excluded from many business’ healthcare plans. It has been a systematic level of discrimination against transgender employees that has a devastating impact on so many people, and it needs to change. In 2002, only 5% of CEI-rated companies included gender identity among their non-discrimination policies and in 2004, only 3% of CEI-rated companies addressed transgender health with limited benefit offerings. Today, 79% of CEI-rated companies provide this limited coverage and 85 companies offer at least one healthcare plan option to all employees that covers many medically necessary transition-related treatments, including hormone therapies and surgeries.

Since 2008 I’ve been an active member of the Human Rights Campaign Business Council. Members provide expert advice and counsel on LGBT workplace issues based on their business experience and knowledge. I, along with all members of the council 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 workplace discrimination and ensure the provision of health insurance.

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. Employers, as consumers of group health insurance products, can advocate on behalf of the transgender people insured on their group health insurance plans. The HRC Corporate Equality Index provides the motivation for employers to work with their insurance carriers or administrators to remove transgender exclusions and provide comprehensive transgender-inclusive insurance coverage.

The new CEI criteria raise the transgender benefit provision requirements significantly for employees, their dependents and applies to business operations throughout the United States, including wholly-owned subsidiaries.

As part of HRC’s commitment to ending discrimination against transgender people, beginning in calendar year 2011 full credit will be given only 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.

In making these changes HRC’s goal remains unchanged; seeking to highlight workplace practices that effectively eliminate discrimination against transgender employees. For the past three years we’ve undertaken a comprehensive review of employer insurance policies and documented tremendous progress. Many businesses have 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 found that placing financial caps for transition related coverage are unnecessary and uncommon and were often utilized to control perceived risk. However, such caps also represent insurmountable barriers to care in many cases. They are discriminatory and the CEI will demand that they be removed. HRC research on utilization has shown that claims costs are extremely low, and therefore risk is low. Only 16 of the 85 businesses currently with full transgender coverage reported a financial cap, ranging from $10,000 to $150,000, and half of these reported caps of $75,000 or greater. 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.

So in summary, much progress has been made by corporations to provide coverage, but work still needs to be undertaken to remove prior discriminatory exclusions for transgender employees and dependents. I truly believe that the latest uplift to the CEI, and the requirement to provide services in order to achieve 100%, will signal a pivotal moment of change for both the employer and transitioning individual.

For more information visit www.hrc.org/cei

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”

So it all seems pretty well from here, IF they can get it together and pull this through this will be a serious help. With so many Dr’s coming out of the wood works doing surgery under insurance as well as so many resources now being shared there is starting to look like a serious hope spreading for this community. For many it will be right on time and many others long past over due BUT I also think it is the best way to getpeople in the workplace and keep them there as well.

Fingers Crossed People,

Salaam

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Comments
  1. HenryHall says:

    >> 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.

    That is a singularly bad choice of criterion at this time in that WPATH has not yet defined any Standards of Care document but practitioners continue to rely on the Standards of Care (sixth version) document promulgated by HBIGDA, the previous association, in February 2001. And that document (HBIGDA SOCv6) actually supports psychopathologisation thereby running counter to the official WPATH De-Psychopatholisation Statement of policy issued on May 26, 2010. See http://wpath.org/publications_public_policy.cfm

    The conflict over psychopathologisation will not be resolved until the WPATH meeting in September 2011.

    It appears that HRC did not consult with the WPATH board of directors before putting out the referenced statement. But better late than never, might I suggest they do so ASAP having realized their blunder!

    • toyneboi says:

      I completely agree this is why the HRC needs to be a little bit more understanding and thoughtful when it comes to the life of everyone in the LGBT community. They have left us out for so long they really do not understand the real issues we have or what standards are really there and what effects they have on us

    • Meghan Stabler says:

      Actually board members, and in particular Jamison Green were consulted and have been actively involved in this. As has Andre Wilson. Both are very well know to the trans community.

      The current SOC was issued in 2001, and now is in the final year of a three year review process. The updated revision is due out in Fall 2011.
      A question we’re often asked is whether this is a medical condition or mental disorder. The growing consensus is that this is a medical condition which can impact psychological health in some individuals, which is probably the understanding we now have of most medical and mental health conditions.
       
      We are referencing:
      Current Standards of Care: Version 6 (2002) http://wpath.org/Documents2/socv6.pdf
      + Clarification Statement (2008) http://wpath.org/documents/Med%20Nec%20on%202008%20Letterhead.pdf

      Transition related coverage ranges from :

      Hormone Replacement Therapy
      Estrogens (also androgen blockers) & Testosterone
      “Growth hormones” (puberty blockers)
      Mental Health Services
      Surgical Reconstruction
      Breast/Chest reconstruction
      Facial reconstruction
      Gonadal surgery
      Genital reconstruction
      Other procedures or services
      – Hair removal (electrolysis), speech therapy

      ….and so on…

      • toyneboi says:

        I agree with you 110% it is a medical condition and if untreated for extended amounts of time can affect the person pyschological health which in turn can be mistaken as a mental disorder. But when the underlying condition is treated it has been proven over and over again that these said “mental disorders” are alleviated in many individual. There are some extreme cases where things are not alleviated and in those situations counseling should be readily available.

  2. This is a really good read for me, Must admit that you are one of the best bloggers I ever saw.Thanks for posting this informative article.

  3. […] HRC's New Corporate Equality Index Requires Removal of Exclusions … […]

  4. Hey, I attempted to email you pertaining to this post but aren?t able to reach you. Please e-mail me when get a moment. Thanks.

  5. This is a really good read for me, Must admit that you are one of the best bloggers I ever saw.Thanks for posting this informative article.

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