Despite the fact that numerous professional organizations have affirmed transgender healthcare as medically necessary, many employee health insurance plans continue to designate transgender healthcare under medical exclusions—limitations and exceptions to services offered under a health insurance plan.
Professional organizations which have affirmed transgender healthcare as medically necessary care and neither experimental nor cosmetic, include:
- American Medical Association
- American Psychological Association
- American Psychiatric Association
- American Academy of Family Physicians
- American Academy of Physician Assistants
- American Public Health Association
- American College of Obstetricians and Gynecologists
- American College of Nurse Midwives
- World Professional Association for Transgender Health
- National Association of Social Workers
- National Commission on Correctional Healthcare
The United States Tax Court has also held that transgender healthcare is medically necessary, constituting as medical care under the Internal Revenue Code.
While the vast majority of major insurance carriers now have transgender inclusive health insurance policy plans available for employers to purchase, many employers do not know to request these inclusive plans for their employee benefit packages.
Transgender-specific medical exclusions not only exclude surgical aspects of transgender healthcare, but also are used to deny transgender policy holders from accessing services that often otherwise are covered for non-transgender individuals enrolled in the plan, such as preventative health screenings, hormone therapy, and mental health services.
A growing number of states have issued insurance regulations informing private insurers and managed care plans that transgender-specific medical exclusions in health insurance plans is prohibited. And an increasing number of states and jurisdictions, now mandate transgender healthcare coverage for their public employees.
This includes the Office of Personnel Management, which now mandates inclusive health insurance for all Federal government employees starting in January 2016, stating that “no carrier participating in the Federal Employees Health Benefits Program may have a general exclusion of services, drugs or supplies related to gender transition.”
No jurisdiction, employer, or insurance company which covers transgender healthcare has found the cost of doing so to be prohibitive.
Additionally, 35% of Fortune 500 employers now provide inclusive heath insurance benefits, including surgical procedures, according to the Human Rights Campaign 2015 Corporate Equality Index.
Last year, the US Department of Health and Human Services (HHS) removed transgender-specific medical exclusions from Medicare, as the exclusions were found to be “unreasonable and contrary to contemporary science and medical standards of care.”
Just this past May, HHS followed up with a guidance that all insurance companies must cover sex-specific preventive care, including mammograms and pap smears, for transgender people, and that that care must be provided without regard to “sex assigned at birth, gender identity, or recorded sex.”
Federal courts and the US Equal Employment Opportunity Commission (EEOC), which enforces federal employment discrimination laws, have also concluded that discrimination on the basis of gender identity (ie because a person is transgender or gender non-conforming) constitutes illegal sex discrimination.
Recent interpretations by federal courts and executive agencies demonstrate an increasing understanding that sex-based protections cover transgender people through an interpretation of the term “sex” that includes gender identity.
Removing transgender-specific medical exclusions is not enough to ensure inclusive coverage will be available for policy holders that require medically necessary care. Clearly articulated written standards that affirm and spell out provisions of effective treatment are necessary for rare conditions where medical expertise is correspondingly rare, where experts are geographically separated, and especially where the condition being treated is the subject of intense social stigma and misperception.
Transgender inclusive employee benefit plans are the first step toward benefits equity for hard-working transgender employees in the St. Louis area.