Gender Prison: Aetna eliminates transgender exclusion for federal employees

Last month I reported on the State Department's decision to ask its insurers to remove the transgender exclusion from its insurance plans and its largest insurer, the American Foreign Service Protective Association's decision to honor that request. The exclusion ends in January.

Last week Aetna announced it will follow suit. Aetna will start covering gender reassignment related health care for federal workers in January.

Additionally, Aetna said it will begin rolling out the same coverage in many of its commercial plans over the next couple of years.

Eight states (beginning with California, Colorado, Oregon, Vermont, and Washington) and the District of Columbia already ban such discimination.

RESOLVED, That our American Medical Association support public and private health insurance coverage for treatment of gender identity disorder as recommended by a physician.

--American Medical Association, 2008

When the City and County of San Francisco made its employee insurance plans transgender-inclusive in 2001, it set up an additional per-employee per-month surcharge to offset the expected additional expenditures. By 2006, it had only spent $386,417 of the $5.6 million it had collected from this surcharge. It ended the surcharge completely:

"Despite actuarial fears of over-utilization and a potentially expensive benefit, the Transgender Health Benefit Program has proven to be appropriately accessed and undeniably more affordable than other, often routinely covered, procedures."

— 2006 letter from San Francisco's Human Rights Commission

A statte of interest is the Unfair Trade Practices Act—a piece of model legislation advanced by the National Association of Insurance Commissioners, which is the standard-setting and regulatory-support organization created and governed by the chief insurance regulators from all 50 states. The Unfair Trade Practices Act contains a broad provision that prohibits unfair discrimination between individuals of the same class and risk for premiums, fees, rates, benefits payable, and terms of a health insurance policy. This provision has been adopted in all but a handful of states.

This statute is a broad prohibition on discrimination by insurers—including in benefits—that requires distinctions made by insurers to be “based on sound actuarial principles or related to actual or reasonably anticipated experience,” rather than based on arbitrary distinctions on the basis of race, sex, gender identity, or other factors. Under this simple statute, nearly every state in the United States has the authority to eliminate gender identity-based discrimination in insurance through a straightforward reading of its own laws.

--Center for American Progress





The usual objection from non-trans people is that they shouldn't have to pay for our healthcare...neglecting the fact that transpeople routinely pay for their care.

No jurisdiction, employer or insurance company which covers trans health care has found the cost to be prohibitive. in 2011 the city of Portland (OR) determined that the cost increase was only .08% of its healthcare insurance budget. The city and county of San Francisco have provided comprehensive coverage for years with research showing no discernible cost.

--Basic Rights Oregon

Twenty-eight percent of Fortune 500 companies...and 340 large employers overall, now cover transgender health services.

There is a petition aimed at New York.

While the Office of Personnel Managements' decision to invite insurers to step forward and act on their own to eliminate the transgender exclusion has been welcomed, it is a rather half-hearted gesture at equal treatment.

In a way, what OPM did was really modest. For years, they told plans that you have to discriminate against employees in the benefit package you offer. Now OPM said, 'At the very least, we're going to say you don't have to do that anymore.

--Harper Jean Tobin, National Center for Transgender Equality

Details of other 2015 health plans are expected to dribble out over the next month.

OPM confirmed Friday afternoon (in a statement after initial publication of the news item) that "a small number of carriers" will offer gender reassignment benefits in 2015. Enrollees should check the OPM Web site for plan details when they're available, the agency advised.

Tobin said she expects OPM eventually will require federal employee health plans to provide this coverage, instead of leaving it optional. Even without the mandate now, Tobin said she's encouraged by insurers' responses so far.

It's very positive to see that even though OPM hasn't flat-out required it yet, that there is going to be some real changes that are really going to benefit people.


The HRC White Paper on Transgender Health Care" Link

Planned Parenthood of the Southern Finger Lakes has created a guide: Providing Transgender-Inclusive Healthcare Services

If you are unfamiliar with the legal status of transgender people, ACLU has it covered.





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