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More employers are covering transgender health benefits

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Researchers estimate that 0.3% to 0.6% of people in the U.S. consider themselves transgender, estimating the population of trans adults in America at around 1.4 million. With such a small figure, employers are starting to see that trans-inclusive benefits aren’t all that expensive, and that the act of adding them to their policies outweighs the limited cost of covering them.

According to the Human Rights Coalition, the number of major U.S. employers adding transgender-inclusive health care coverage rose from 49 in 2009 to 278 in 2013, hitting a record 849 in the 2019, as recorded by the HRC’s Corporate Equality Index.

As trans individuals have gained awareness of such benefits through the media, employers have also expanded their knowledge of trans employees and their health and benefits, and are making changes to become more inclusive. But caring for the health of trans employees requires long-term thinking and sensitivity.

Over the past decade, large and small businesses have removed transgender exclusions from their health insurance contracts, largely as a result of the Affordable Care Act and new regulations enacted during the Obama administration. These new regulations helped to modify clinical guidelines to provide health insurance coverage for mental health counseling, hormone therapy, medical visits, surgical procedures and other treatments related to gender transition or sex reassignment.

In addition, more companies are adhering to nondiscrimination policies and gender transition guidelines and adding access to inclusive healthcare. In its 2019 report, the HRC designated more than 570 businesses as being a “Best Place to Work for LGBTQ Equality.”

The report also found that 853 employers are now offering transgender-inclusive health benefits. That includes 62% of Fortune 500-ranked businesses.

But even for smaller companies, adding trans-friendly health plans can send a powerful signal. While these benefits are typically used by a small segment of employees, the availability and sensitivity to these issues helps to create an environment that supports diversity and inclusion and creates an advantage in hiring top talent. Additionally, trans employees who work in organizations with trans-friendly policies say they are more inclined to stay longer at that organization and feel more secure in their roles.

Providers more aware of trans health issues

As acceptance of trans health issues has grown among employers, the medical field has been playing catch-up to become more inclusive to trans individuals’ unique needs. Major medical groups like the American Medical Association, the American Psychological Association and the American Academy of Pediatrics have created detailed guidelines for providers working with trans youth and adults. Such education and guidance includes combatting discrimination against trans patients, including placing restrictions on the care or coverage a transgender person can receive.

Awareness of trans health issues must start well before providers start seeing patients, which led Harvard Medical School to create the Sexual and Gender Minorities Health Equity Initiative in 2018. The initiative identifies opportunities on how doctors can better instruct on the health of sexual and gender minorities. Studies have shown that when medical students learn about transgender health issues, they feel better equipped to treat transgender patients. Boston University School of Medicine added transgender health content to a second-year endocrinology course, and students reported a nearly 70% decrease in discomfort with providing transgender care.

The New England Journal of Medicine emphasizes that LGBTQ+ health must be covered at all levels of training, including graduate medical education and continuing medical education. (only one jurisdiction — Washington, D.C. — currently requires physicians to complete education related to LGBTQ+ health). In addition, the journal stresses that academic medicine institutions must enhance their faculty development and training to improve instructors’ understanding of LGBTQ+ patients' needs.

The need for trans health education among providers isn’t just essential for providing unique care related to transitioning, but is also needed to ensure that trans individuals feel comfortable seeking care for more routine health issues such as managing weight, stress, and sleep issues, as well as mental health needs. According to the American Medical Association and the American Psychiatric Association, trans people who receive adequate care are less likely to struggle with emotional stress.

Sensitive to pronouns, forms, exams, and language to be gender-neutral

Creating a work environment that is inclusive to trans individuals starts with policy changes geared explicitly toward trans and non-binary employees. Best practice health care policies should cover all gender confirmation procedures according to standards set by the World Professional Association for Transgender Health, without a lifetime maximum benefit.

But awareness of how policies are perceived by employees should also be carefully reviewed for inclusion.

Misgendering remains a common microaggression that trans and nonbinary workers report experiencing regularly; bathroom access also remains a fraught issue. Even standard HR forms that divide employees into only male and female categories or make assumptions about an individual’s health can create fear and uncertainty for trans employees.

To help major companies be more inclusive of trans employees, we at StayWell recently revamped our health risk assessment and biometric screening forms to be gender nonbinary and include health issues that may be impactful for trans individuals. This shift requires thinking differently about employee health.

While changes to screening forms may seem like a small shift, it helps to create greater awareness for employers and helps to build an environment where trans employees feel more comfortable to be their authentic selves. And by including these types of changes in employee benefit packages, employers can also help trans employees better manage their health and reduce the risk of more serious health issues in the future.

Navigating health-related issues by gender

While major corporations may set a certain standard for their industry, many more trans individuals work at organizations that may have less inclusive benefits. Smaller employers may be wondering how to help trans employees manage their health. According to the HRC, small employers and business owners can start by making sure forms are gender-neutral and/or trans-inclusive. This should include HR and health benefit forms. Additionally, they encourage company leaders to reduce assumptions of health risks based on gender.

Most drivers in health care costs are attributable to modifiable health choices such as diet, exercise, quality of sleep. By helping employees improve these areas of their health, employers can help to reduce health care costs regardless of their gender. Employers may also want to consult with a broker or third-party to help ensure policies and programs are trans-inclusive, ensuring an environment that is inclusive of all.

Employers who continue to fall back in trans inclusive policies will paying the price in recruiting and retention. When searching for meaningful employment, individuals look for employers with cultures that reflect their own values and inclusivity. In a job market with only 3.5% unemployment, employers are in a race to secure top talent, and offering an inclusive benefits package can differentiate them from competitors. And it helps to make a workforce that is more tolerant, accepting and affirming of our individual differences.

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