The largest national supermarket chain Kroger recently announced that beginning January 2016, it will cover transgender health benefits, including surgery and drug therapy for gender reassignment, to eligible employees enrolled in the company’s health insurance plan.

By implementing these benefits, Kroger joins hundreds of major employers on the Corporate Equality Index which lists benefits with transgender-inclusive health insurance benefits including Apple, Best Buy, Coca Cola and Ford Motor Company.

Also see: Insurers can't deny gender transition treatment under U.S. plan

Kroger spokesperson Keith Dailey says a notice was posted on the company’s internal social networking site explaining that the medical procedures, including surgery and drug therapy for gender reassignment, will be covered up to a $100,000 lifetime maximum for eligible associates and their dependents enrolled in the company health plan.

Employers that want to determine whether or not their health insurance includes transgender-inclusive benefits can access resources posted by the Human Rights Campaign.

Alison Gill, senior legislative counsel for the Human Rights Campaign, says the potential cost increases due to offering transgender health care is extremely minimal because the population is small. ”It’s almost imperceptible based on standard health care usage of most corporations,” she says.

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According to the Human Rights Campaign, the best available public data on insurance coverage experience is from the City and County of San Francisco. In the period from 2001-2006, the cost per insured per year averaged between $0.77 and $0.96, or less than a dollar per year per enrollee.

Transgender people access health care for all the same reasons anyone else does, but sometimes their transgender status is regarded by insurance carriers (and some care providers) as a barrier to care, even when that care is not related to a transition (i.e., reconstruction and alignment of sex characteristics from male to female, or from female to male, through the use of hormones and/or surgical interventions).

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When a transition is in process, it may involve one or more types of medically necessary treatments. Most of these types of treatments are typically covered for other medical diagnoses, but many health insurance policies specifically exclude sex affirmation/reassignment-related treatments. The effective scope of those exclusions can vary significantly from one insurance plan to another.

Currently 19 U.S. states and Washington D.C. explicitly include “gender identity” in their anti-discrimination statutes. Only 10 of these states plus the District of Columbia have made it clear that insurance providers cannot arbitrarily put bans on coverage for transition-related care.

While it is still a developing area of the law, “I think there is a reasonable case to be made that in the other nine states, non-discrimination means you can’t discriminate in health care and of course that’s the way it’s interpreted at the federal level,” says Gill.

To provide added protection on a national basis, in September of this year the U.S. government also said it will extend the health care non-discrimination law provisions of the Affordable Care Act to transgender individuals, requiring health insurance and medical providers to treat all patients equally, regardless of sex.

The proposed rule would apply to any health care entity in the country that receives federal funding. “This will extend far more broadly than doctors who participate in government health care programs like Medicare or Medicaid and to insurers who provide these and other government plans,” Gill says. “It will also apply to hospitals that receive funding through Medicare or Medicaid or anyone involved with insurance exchanges established under the ACA – which includes the vast majority of insurance providers.”

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The National Centre for Transgender Equality has been advocating for legislative and policy changes for years. Executive director Mara Keisling told Reuters, “The medical and scientific consensus has long been that transition-related care is medically necessary and should be covered by insurance.”

Dailey says Kroger made the decision after consulting with their GLBT associate resource group, the Alliance of Kroger.

“We are excited to be able to make this announcement. For the last few years the Alliance of Kroger has made a dedicated effort to work with executive leaders and the total rewards leadership team to secure these benefits for our associates.”

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