DAVID TAFFET  | Senior Staff Writer

The city of Dallas has added gender transition, including gender reassignment surgery, to its health insurance coverage for its employees. The new benefit will pay up to a $75,000 lifetime maximum benefits.

Hormonal therapy is covered separately by the plan’s pharmacy benefits.

The transition benefit was recommended by the Mayor’s LGBT Task Force, but implementation was held up by the last two city managers.

When T.C. Broadnax became Dallas’ new city manager last December, members of the task force scheduled a meeting to discuss the additions with him.

Broadnax and the task force members also discussed coverage of breast augmentation and reduction surgeries at that meeting, with some suggesting that if coverage for breast augmentation were offered, every woman who worked for the city would want the procedure.

But Broadnax saw the difference between cosmetic and medically necessary procedures and expressed surprised that if a woman was having back pain and her doctor recommended a breast reduction surgery, the city policy wouldn’t necessarily cover it. And the idea that every woman would want breast augmentation surgery if it were covered was, he suggested, ridiculously sexist.

Covering gender transition in other cities has been surprisingly inexpensive. The city of San Francisco prepared for a deluge of claims after adding the coverage. But during the first year, only two people took advantage of the benefit, and the plan increased in cost by only about $1.30 per insured person per year.

Within a few years, the plan was running almost a $5 surplus after spending $135,000 on benefits the first year. The actual cost to that city has been about 80 cents per employee.

Leslie McMurray, a transgender woman who works for Resource Center and serves on the Mayor’s LGBT Task Force, spoke to the city manager’s office about adding gender transition benefits. She said the $75,000 figure came from Cigna, the company that manages the city’s healthcare plan, and added that from her own experience that amount would be adequate.

“Trans guys [might spend] that amount if they went the full route,” she said. But many trans men that she knows only have top surgery, at a cost of about $10,000.

“Mine was $30,000,” McMurray said of her gender reassignment surgery. She also spent about $10,000 on electrolysis and was quoted another $30,000 for a full range of facial work.

She compared the cost to employees with diabetes, which costs about $11,000 per year to treat.

“With us, once you’re done, you’re done,” she said, explaining there were no additional costs. “And the number of people who want surgery is low.”

There are, McMurray noted, added benefits: “The policy tells people what kind of city Dallas is,” she said.

Austin is the only other city in Texas with similar coverage for city employees.

Having this benefit in place may also make it easier for transgender employees to come out, even if they’re not going to take advantage of the benefit.

“The goal of transition is not necessarily surgery,” McMurray said. “The goal is to alleviate gender dysphoria.”

Sometimes involves hormones, McMurray said, but sometimes it might involve nothing more than changing hair and make up.

And yes, sometimes it involves surgery. But having the option of surgery in place and knowing a person’s employer would pay for surgery if the employee wanted it could be enough to relieve someone’s discomfort at coming out.

McMurray praised Broadnax for understanding the difference between breast augmentation for cosmetic purposes and that done for medical purposes. She noted that there’s a difference between someone who had breast cancer and wants reconstruction or someone with back pain and needs breast reduction or someone who needs breast augmentation for gender transition and a woman who wants surgery for cosmetic purposes.

McMurray said not including medically necessary procedures is “punishing trans people for something you’re afraid other people are doing.

“Gender transition is medically necessary for some people and that should be determined by patient and doctor and not by the employer,” she said.

This article appeared in the Dallas Voice print edition March 24, 2017.