The LGBTQ+ community faces barriers in access to healthcare that many of us take for granted. These barriers are especially notable in fertility/reproductive and gender-affirming care. Though progress has been made toward expanding global coverage and eligibility for these essential services, more must be made. HR and Operations staff members in every country have a unique and invaluable opportunity for advocacy during each benefit renewal process with an insurance carrier, whether switching carriers or keeping an existing plan.
What can I do?
Ask questions. By asking insurance carriers thoughtful and detailed questions about the eligibility for coverages and the definitions of services, you highlight the demand for comprehensive and just benefits for all populations, and you proactively head off potential challenges that your employees may face in the future.
HR managers can commit themselves to undertaking this due diligence, whether or not employees are actively bringing barriers to the attention of HR. This is also not a process that is specific only to American HR managers. Statistics prove that such due diligence results in richer, more just benefits plans for all employees who rely on insurance for any part of their medical benefits.
Ask for answers from the carrier in writing. A few questions to get you started:
- What type of gender-affirming care does this policy provide? Which surgeries are covered, and under what circumstances?
- Who is eligible for those surgeries, and what type of documentation will be required?
- What type of fertility treatment does this policy cover, and what is the eligibility for that care?
- How does this policy define ‘failed attempts’, and does your company recognize the undue burden this definition places on same-sex couples?
- Are there wait times associated with the approval process?
- What caps on services exist in this plan? How did you reach that cap?
Medical benefit plans are more flexible than you may realize; where you identify weaknesses – like low monetary caps or exclusionary eligibility criteria– you can negotiate for the improvements you want. Your insurance broker should be your partner in advocacy.
These negotiations add up to change industry standards, and changes expand future access to healthcare worldwide. As employees utilize this type of healthcare, the resulting data informs insurers about the market and directly results in improved understanding and openness toward underwriting care.
What types of barriers will this address?
This process yields tangible results for our clients in many healthcare categories. Four of those are particularly relevant for some members of the LGBTQ+ community.
- Expanding coverage for top surgery as an essential aspect of gender-affirming care Advocacy by employees, HR managers, and brokers lead to greatly expanded access to top surgery by rejecting the classification of this type of healthcare as ‘cosmetic.’ While not yet industry-standard, it’s now fairly straightforward to insist that coverage for this specific care is included in a policy.
- Removing monetary caps on care that were not set with the needs of LGBTQ+ employees in mind Caps on coverage – like a $20,000 lifetime cap on fertility care – are negotiable. Keep in mind that this type of standard, created and applied to a global workforce without considering the differing needs of employees, is rarely appropriate.
- Revising the definition of ‘failed attempt’ to lower barriers to fertility care for some same-sex couples While innocuous at first glance, undertaking and documenting a ‘failed attempt’ at becoming pregnant places onerous barriers on some same-sex couples, who must pay thousands of dollars to undertake a failed insemination. Heterosexual couples may have access to ‘failed attempts’ for free. This type of onerous barrier has no place in a high-quality, comprehensive benefits policy.
- Including coverage for egg banking in medical policies
All families should be free to choose reproductive timing that fits their needs. Options like egg banking can increase choice for all families, including some same sex couples. This type of care can be included in medical policies.
There’s a long way to go toward justice in access to healthcare for the global LGBTQ+ community. But this June, let’s acknowledge the advocacy that has led to tangible evolution in the insurance industry and commit to continued advocacy toward equity for all.