Understanding often is the road to acceptance. Perhaps no one knows that better than members of the transgender community, who routinely face scrutiny and rejection from the general society. Transgender people, self-named “trans” for short, don’t identify with the gender to which they were born. Their desire to be the opposite sex, or neutral in the case of nonbinary people, isn’t by choice, explains Transequality, an LGBT advocacy agency. The desire is physiological and sometimes appears in early childhood.

Workplaces must be ready for more transgender hires. LGBT activist groups are leading movements to lower high-poverty and unemployment rates among trans people and advocating for their acceptance by society. Progressive employers are answering the call, hoping to meet their diversity commitments. To date, 325 companies in the Fortune 500 category have nondiscrimination policies on gender identification, reports the Human Rights Campaign, a prominent LGBT advocacy agency. Its Corporate Equality Index 2015 study shows that major corporations offering “transgender-inclusive” healthcare benefits have increased 10 times in six years, from 49 in 2009 to 418 in 2015.

California is funding a jobs program to encourage restaurant owners to hire transgender workers. San Francisco is following suit with a similar program. Both state and city are the first in the nation to focus on employment opportunities for transgender people.

High-tech giant SAP is extending more health benefits to its transgender workers in 2017. The company added facial reconstruction and a puberty-arresting drug for minors to the psychological counseling and gender reassignment services it already offers. Dependents are covered under the benefits plan, as well.

Knowing  transgender challenges is a first step in offering healthcare coverage

What’s it like being one of the 1.4 million trans in the U.S.? Transgender adults and children expressed their most negative experiences in interviews on the transequality.org website. Common feelings are:

• Fear of rejection
• Fear for physical safety
• Anxiety about which restroom to use
• Frustration over healthcare denials
• Sadness about being the target of cruel jokes and comments

A study on the trans community’s economic status titled, A Broken Bargain for Transgender Workers, sets their unemployment rate at 14%, which is twice the national average of 7%. In fact, nearly half of transgender workers, or 44%, are unemployed, with average annual household incomes of less than $10,000.

Transgender people have unique health concerns that employers must recognize

Transgender people are at particularly high risk for certain health disorders. Companies can offer trans more tailored healthcare benefits by knowing what the risks are. The greatest health concerns for trans are…

• Healthcare coverage denial: Transgender people are regularly denied medical coverage, rejected by healthcare providers or have had negative medical experiences. Providers don’t always know how to treat them, and some medical plans don’t offer coverage at all. Vanderbilt University studies conclude that fear of rejection might prevent some trans people from seeking treatment.
• Hormone-therapy risks: Transgender people are often prescribed hormone therapy for sex changes. But hormones have risks: high doses of testosterone have been known to cause liver damage, and estrogen can raise blood pressure and cause blood clots. Other hormones make blood pressure levels too low, upset electrolyte balances and cause dehydration.
• Cancer: Transitioning from female to male increases the risk of cancer in candidates whose uterus, breasts and ovaries are still intact. Female transgender people are at risk for prostate cancer, although the risk is small.
• Depression: Transgender people suffer from depression and anxiety more than other groups.  Depression is highest when transgender people lack social support or are can’t openly identify with their true gender. 
• Other health risks: Transgender people are at risk for other health conditions common among the general population, such as heart disease, sexually transmitted diseases and substance abuse.

Employers might need to negotiate plan designs with insurers to remain inclusive

Many health insurers still use exclusions such as “sex-change-related services” or “surgery for sex reassignment” to deny transgender people coverage. Employers that want to be inclusive will need to be proactive about partnering or negotiating with plan providers for adequate coverage. Human Rights Campaign data shows that employers have petitioned insurers to remove exclusions from their plans.

Data also shows that even among insurers that provide transition coverage for transgender people, plans don’t always offer the kind of treatment that’s needed. The Human Rights Campaign noted that employers concerned about adding services to their plans often meet opposition from insurers based on misunderstandings and a lack of knowledge about transgender people’s medical needs.  

Employers are more successful in negotiating transition-related coverage with insurers when they come prepared with authentic data on transgender people, their medical needs and social challenges.  

Click here for some helpful negotiating tools.