Latest / The Diversity Career Podcast with Fexingo: Inclusion, Equity, and Underrepresented Professionals / How One Company Funded Transition-Related Health Care
Transcript
- Lucas: If we've helped you think through a career move or decision — maybe you've used one of our episodes to make a case at work or to advocate for a change in your own team — then a couple of dollars a month is genuinely what keeps these going. Buy me a coffee dot com slash fexingo, if you've gotten something out of them. Luna: Yeah, it's a small thing that adds up. And it means we don't have to run ads or chase sponsorships. Lucas: Exactly. So back to the topic — let's talk about a benefit that some companies still treat as optional, even though the data says it's anything but. Luna: You're talking about gender-affirming health care. Lucas: Yes. And I want to anchor this on a specific company that made the decision early: Vanguard. The investment giant added coverage for gender-affirming surgery and transition-related care to its employee health plans back in 2015. Luna: That was pretty early for a large, conservative-leaning company like Vanguard. What exactly did they cover? Lucas: The plan includes hormone therapy, mental health counseling related to transition, and surgical procedures — both chest and genital reconstruction. They also cover voice therapy and hair removal if deemed medically necessary. Vanguard worked with an outside expert — the Human Rights Campaign's Corporate Equality Index team — to make sure the coverage was comprehensive. Luna: So it wasn't just a checkbox — they actually designed it to meet real medical needs. Lucas: Right. And the business case they used internally is instructive. Turnover is expensive. For a transgender employee who has to pay out of pocket for care — sometimes tens of thousands of dollars — the likelihood of leaving a company that doesn't cover it is high. Vanguard estimated that the cost of covering transition-related care was far less than the cost of replacing a single senior employee. Luna: Do you have a sense of how many employees actually use this benefit? Lucas: It's a small number. At most companies, less than one percent of employees will utilize transition-related coverage in a given year. The cost per employee per year is often less than a dollar. That's the figure Vanguard pointed to when it presented the proposal to its benefits committee. Luna: So the financial risk is tiny, but the impact on the individual is enormous. Lucas: Exactly. And the ripple effect is real. After Vanguard, American Express expanded its coverage in 2017 to include all medically necessary transition care. Target had already been covering it since 2014. Now over 900 major employers offer some form of gender-affirming coverage, according to the Human Rights Campaign's most recent Corporate Equality Index. Luna: So if I'm an HR leader at a company that doesn't offer this, where do I start? Lucas: First, you need to know what your current plan excludes. Many plans have blanket exclusions for anything related to gender transition — they'll say 'services related to sex change are not covered.' That language has to be removed. Then you work with your insurance carrier to add specific CPT codes for hormone therapy, mental health, and surgery. Luna: And you probably need a medical director who understands transgender health. Lucas: Critical. Some carriers have a transgender health specialist who reviews claims. If yours doesn't, you can contract with a third party like the Maven Clinic or the World Professional Association for Transgender Health for guidance. The next step is to benchmark against competitors in your industry — because if you're a tech company and you don't offer this, you're losing talent to firms that do. Luna: And what about the communication piece? How do you let employees know this benefit exists without outing anyone? Lucas: That's the tricky part. You can't just send a company-wide email saying 'hey, we now cover gender-affirming surgery.' Instead, you update your benefits guide, you train your HR team, and you make sure the information is available on your intranet. Some companies also work with employee resource groups to spread the word quietly. Luna: Right — you want people to know it's available without forcing anyone to disclose. Lucas: Exactly. And then you follow the data. After implementation, track utilization, employee satisfaction, and turnover among transgender employees. Vanguard saw no significant increase in overall health costs, and the feedback from employees was overwhelmingly positive. That's the kind of internal data that makes the case for the next benefit expansion. Luna: So it's not just a moral argument — it's a retention argument with a very low price tag. Lucas: It's both. And for companies that haven't done it yet, the path is clear. The template exists. You don't have to invent anything. Luna: Yeah, and the risk of not doing it is rising. Younger workers — especially Gen Z — are increasingly looking at benefits like these when deciding where to work. Lucas: That's a good point to end on. The benefit itself costs next to nothing, but the signal it sends about your company's values — that's priceless.