Employer provided benefits play a vital role in the lives of many transgender and non-binary people. Not all individuals will choose to transition medically, but for those that do, access to affirming care through insurance is necessary for their safety and happiness. This is not a short-term need since those that have transitioned will generally continue to require routine transition-related care for the rest of their lives.

The stakes here can be very high. People experiencing untreated Gender Dysphoria can suffer intense psychological distress. If a workplace doesn't provide needed coverage it can keep a candidate from accepting a job offer, cause a valued employee to look for another job, or worse.

Note: This information is targeted toward employers in the United States. Since the U.S. does not have single-payer health coverage, employers commonly provide health insurance coverage.

Health Insurance

Transgender and non-binary employees and dependents need access to medical care for many of the same reasons others do, but they may also need access to one or more types of medically necessary treatment related to their transition. This treatment is supported by many medical organizations and outlined in the WPATH Standards of Care.

Questions

  • What is your insurance carrier's clinical policy bulletin on transgender care? See examples at Transcend Legal.

    • Your insurance company may classify non-binary individuals as transgender and include them under this bulletin even though non-binary individuals may not consider themselves transgender.
  • Even if your carrier has a bulletin, does your insurance policy contract contain any coverage exclusions or limitations for transgender-specific treatment?
  • If there are coverage exclusions or limitations, will your insurance company treat a person's transgender or non-binary status as a barrier to unrelated care?
  • If your contract does not specifically exclude or affirm coverage, are you able to reach out to an experienced benefits manager to determine available coverage?
  • Do you need an explicit rider to your contract that affirms coverage?
  • Do HR staff know the details of the coverage that is available or where to find that information when asked?
  • Do employees and interviewing job candidates know what coverage is available to them through your organization?
  • Is there anything you can do as an organization to make the process of seeking care easier for those transitioning? For instance, can you assign a company advocate to help navigate insurance requirements and push back on denials of coverage?

  • What does your insurance plan specifically cover?

    • Mental health coverage
    • Hormone Replacement Therapy (HRT)
    • Lab work for maintaining correct hormone levels
    • Hair removal via electrolysis and laser
    • Voices lessons and voice therapy
    • Gender affirming surgeries
    • Top surgery
    • Bottom surgery
    • Facial feminization or masculinization surgery
    • Vocal modification surgery
    • Hair transplants

External Resources

Medical Leave

Many transitioning individuals will need time away from the workplace in order to deal with their transition. This could include something as simple as taking a mental health day due to dysphoria or it could be an extended leave to deal with recovery from a major surgery.

Questions

  • Does your medical leave policy cover medical treatment as a part of a gender transition?
  • Do you allow employees to work from home when necessary?
  • Transitioning individuals may not wish to disclose details about why they are not at work if it's related to their transition. Have you created a culture where employees aren't required or expected to justify leave with personal details?

Other Benefits

Consider any other benefits that may be gendered at your organization.

Questions

  • Does your parental leave policy cover trans men and non-binary parents who carried their child?
  • Could your parental leave policy cover any parent, regardless of gender or whether they are biologically related to their child?
  • Could your parental leave policy grant the same amount of time to parents of all genders?