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Why providing transition healthcare coverage to transgender employees makes sense

LOS ANGELES — Employers report zero or very low costs and yet substantial benefits, for them and their employees alike, when they provide transition-related health care coverage in their employee health benefit plans, according to a new study.

The report, “Costs and Benefits of Providing Transition-related Health Care Coverage in Employee Health Benefits Plans: Findings from a Survey of Employers,” released today, finds that a majority of employers reported that they would encourage other employers to add the coverage, and none would advise against it.

“This study explored the experiences of 34 employers providing transition-related health care coverage for 2 million individuals,” said the report’s author, Jody L. Herman, Williams Institute manager of transgender research.

“The findings based on such a large sample should reassure employers they will incur little to no cost when extending such coverage.”

Thirty-four employers participated in a survey to describe their transition-inclusive health benefits plans, how much these plans have cost them, and what, if any, benefits they receive from providing their transition-inclusive plans. Key findings from the survey include:

• 85% of the 26 employers that provided information on costs of adding coverage to their existing health benefits plans reported no additional costs to add the coverage.

• Two-thirds of the 21 employers that provided information on actual costs from employee utilization of the coverage reported zero actual costs due to utilization.

• Based on the experiences of surveyed employers, we would predict that 1 out of 10,000 employees (among employers with 1,000 to 10,000 employees) and 1 out of 20,000 employees (among employers with 10,000 to 50,000 employees) will utilize transition-related health benefits annually when they are available.

• The type, number, and cost of services accessed by individuals will vary, yet as described above, the costs of these benefits, if any, are very low, as is the utilization of the benefit.

The report identified some potential issues in regard to access to coverage and health care that would be medically necessary if clinically indicated for an individual, according to the WPATH Standards of Care. While 100% of the employers covered most hormone therapies and genital surgeries for transition, only 59% covered breast or chest reconstruction and only a quarter covered electrolysis, certain facial procedures, and voice-related procedures. Further, 48% had some restriction on access to transition-related health care provided out-of-network. Notably, providing broader coverage did not result in higher costs for surveyed employers.

“Ensuring that employees are covered for the full range of medical treatments or surgical procedures that they may need, and have access to the healthcare professionals that provide them, deserves additional attention from business leaders and policymakers,” Herman said.

Employers further reported a variety of positive motivations for providing this coverage:

• 60% reported it would help them compete as an employer within their industry and would help with recruitment and retention.

• 60% stated it reflected their corporate values, including equality and fairness.

• 48% said they were motivated to improve employee satisfaction and morale.

• 44% noted it demonstrated their commitment to diversity and inclusion.

These findings are consistent with prior research that has shown employers generally benefit from providing LGBT-inclusive workplace policies.

Survey participants for this study were all employers known to provide transition-related health care coverage for employees through their health benefits plans. To identify these target participants, researchers relied on the 2013 Corporate Equality Index from the Human Rights Campaign and existing knowledge networks to identify city, county and university employers. The survey was announced via email in December 2012 to a total of 243 employers, utilizing personal contacts and LGBT employee resource groups.

A digital version of the report is available online HERE.