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

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 ,000 to 0,000, and half of these reported caps of ,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 ,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


Human Rights Campaign | HRC Back Story

—  John Wright

Partner denied sick leave by AT&T

Bryan Dickenson, left, and Bill Sugg hold hands in Sugg’s room at a rehabilitation facility in Richardson on Wednesday, Jan. 27. (Source:John Wright/Dallas Voice)

Despite 100% rating from HRC, company won’t allow gay man time off to care for ailing spouse

JOHN WRIGHT  |  News Editor
wright@dallasvoice.com

Bryan Dickenson and Bill Sugg have been together for 30 years.

For the last 12 of those years, Dickenson has worked as a communications technician for Dallas-based AT&T.

After Sugg suffered a debilitating stroke in September, Dickinson requested time off under the federal Family Medical Leave Act to care for his partner.

But AT&T is refusing to grant Dickenson the 12 weeks of leave that would be afforded to a heterosexual spouse under the act.

As a result, Dickenson is using vacation time so he can spend one afternoon a week at Sugg’s bedside at a rehabilitation facility in Richardson. But Dickenson fears that when his vacation runs out, he’ll end up being fired for requesting additional time off to care for Sugg. Dickenson’s attorney, Rob Wiley of Dallas, said he initially thought AT&T’s refusal to grant his client leave under FMLA was just a mistake on the part of the company. Wiley said he expected AT&T to quickly rectify the situation after he sent the company a friendly letter.

After all, AT&T maintains the highest score of 100 percent on the Human Rights Campaign’s Corporate Equality Index, which ranks companies according to their treatment of LGBT employees. And just this week, HRC listed AT&T as one of its “Best Places to Work.”

But AT&T has stood its ground, confirming in a statement to Dallas Voice this week that the company isn’t granting Dickenson leave under FMLA because neither federal nor state law recognizes Sugg as his domestic partner.

“I really couldn’t be more disappointed with AT&T’s response,” Wiley said. “When you scratch the surface, they clearly don’t value diversity. I just think it’s an outright lie for AT&T to claim they’re a good place for gays and lesbians to work.”

Wiley added that he’s disappointed in HRC for giving AT&T its highest score. Eric Bloem, deputy director of HRC’s workplace project, said Thursday, Jan. 28 that he was looking into the matter. Bloem said a survey for the Corporate Equality Index asks companies whether they grant FMLA leave to same-sex couples, and AT&T replied affirmatively.

“I’m not exactly sure what’s going on, so I don’t really want to make an official comment on it,” Bloem said.

Walt Sharp, a spokesman for AT&T, said the company has “a long history of inclusiveness in the workplace.”

“There are circumstances under which our administration of our benefits plans must conform with state law, and this is one of those circumstances,” Sharp said in a written statement. “In this case, neither federal nor state law recognizes Mr. Dickenson’s domestic partner with legal status as a qualifying family member for a federal benefit program. There is no basis for this lawsuit or the allegations contained in it and we will seek its dismissal.”

Sharp didn’t respond to a request for further comment.

Wiley said Sharp’s statement doesn’t make sense. No law prohibits the company from granting Dickenson an unpaid leave of absence, which is what he’s requesting. Wiley also noted that no lawsuit has been filed, because there isn’t grounds for one.

The federal FMLA applies only to heterosexual married couples, Wiley said. Some states have enacted their own versions of the FMLA, requiring companies to grant leave to gay and lesbian couples, but Texas isn’t one of them.

Wiley said the couple’s only hope is to somehow convince the company to do the right thing, which is why he contacted the media.

“At some point in time this just becomes really hateful that they wouldn’t have any compassion,” Wiley said of the company. “I think the recourse is to tell their story and let people know how AT&T really treats their employees.”

Through thick and thin

This isn’t the first time Dickenson and Sugg have endured a medical crisis.

Sugg, who’s 69 and suffers from congenital heart problems, nearly died from cardiac arrest shortly after the couple met in 1980.

At the time, Dickenson was a full-time student and didn’t have car. So he rode his bicycle from Garland to Parkland Hospital in Dallas every day to visit Sugg in the intensive care unit.

In an interview this week at the rehab facility, Sugg’s eyes welled up with tears as he recalled what a Parkland nurse said at the time – “If that isn’t love, then I don’t know what the hell love is.”

“And sure enough, it was,” Sugg said over the whirr of his oxygen machine, turning to Dickenson. “As long as I have you, I can get through anything.”

Dickenson said in addition to visiting Sugg each Wednesday afternoon, he wakes up at 7:30 on Saturday and Sunday mornings so he can spend the day with Sugg at the rehab facility.

This past Christmas, Dickenson spent the night on the floor of Sugg’s room.
“That would have been our first Christmas separated, and I just couldn’t bear that, him being alone on Christmas,” Dickenson said.

The worst part of the whole ordeal was when he had to return to work after taking 13 days off following Sugg’s stroke, Dickenson said. Sugg didn’t understand and thought his partner had abandoned him for good.

“He called me over and over every night, begging me to please come see him,” Dickenson said. “And I said, ’Honey, you don’t understand, I had to go back to work to save my job.’

“That’s what really hurts about what they’ve put me through, not my pain and anguish, but his,” Dickenson said.

Dickenson said it was 3 a.m. on Sept. 22 when he rushed Sugg to the hospital. Doctors initially said it was “the worst sinus infection they’d ever seen,” but within 48 hours Sugg had suffered a stroke affecting his cerebellum.

Sugg lost the ability to swallow and his sense of balance. He’s still unable to walk and suffers from double vision.

Because he wasn’t out as gay at work, Dickenson initially told supervisors that his father was sick.

When he returned to work after 13 days at the hospital, Dickenson explained that his domestic partner was ill and he needed more time off. His supervisor managed to get him an additional 30 days of unpaid leave.

In the meantime, Dickenson phoned the company’s human resources department and asked whether he’d be eligible for leave under FMLA, which allows 12 weeks (or about 90 days) per year. Dickenson said he was told that since he lives in Texas, he wouldn’t be eligible.

Dickenson filled out the FMLA forms anyway and sent them to the company, but he never got any response.

When Dickenson returned to work, he asked to be reclassified as part-time employee, so he could spend more time with Sugg. His supervisor refused and told him his best bet was FMLA leave, even though he’d already been denied.

That’s when Dickenson contacted Wiley.

Sugg is scheduled return to the couple’s Garland home from rehab in about a week, but he’s still on a feeding tube and will require nursing care. With any luck, he’ll someday be able to walk again.

Sugg bragged that he was able to drink his first cup of coffee last week, and he’s looking forward to getting back to his hobby of raising African violets.

Dickenson said he knows of at least seven medical appointments he’ll have to arrange for Sugg once he returns home. He said his vacation time likely will run out by April, and he fears that if he loses his job, the medical expenses will eventually cause him to go broke.

But Dickenson, who’s 51, said he’s committed to taking care of Sugg, even if it means living on the street someday.

“When it runs out, I’ll be fired, and it really hurts to be in a situation like that, because I’ve worked very hard for AT&T,” Dickenson said. “We suffer now, but maybe other people in our shoes in the future, if they work for AT&T, they won’t suffer like we do.”

—  John Wright