IUSM position statement on trans inclusive health care

Indiana University School of Medicine
Office of Diversity Affairs
Diversity Council
Committee on LGBTQ Health

A position statement on transgender health insurance coverage at Indiana University School of Medicine

This statement recommends that all health insurance plans for employees, students and trainees, associated with the Indiana University School of Medicine include full coverage for services related to transgender care for its employees, anyone covered by the employee’s plan of choice and students/trainees who are covered by a University provided health plan.

  1. Coverage should include all services related to gender transition (e.g., medically necessary services related to: gender affirmation; mental health services; pharmaceutical coverage; coverage for medical visits and laboratory services; and coverage for all reconstructive surgical procedures and procedures specifically related to one’s gender transition). Coverage should span the age spectrum to include children and adults.
  2. Equal health coverage should be extended to transgender individuals, as deemed appropriate by the patient’s physician and access or payment for care should not be restricted based upon one’s legal gender marker. For example, preventive services such as mammography and cervical cancer screening for transgender men, or prostatic cancer screening for transgender women must be covered.
  3. As a corollary to these points, exclusions in health insurance plans provided by the University to employees and students/trainees based on appropriate transgender care should be eliminated.

Any exclusions of medically necessary services for transgender employees, students, and trainees is unethical practice, is discriminatory, and contradicts the values and mission of the IU School of Medicine and Indiana University. This statement confirms commitment of the IU School of Medicine to the citizens of Indiana to assure equitable health care for all.

Support points and sources

  1. Discrimination in access to health care is a common experience of transgender people, and contributes to important health inequities, compared to cisgender people. (Nadal KL, et al., Micro aggressions Toward Lesbian, Gay, Bisexual, Transgender, Queer, and Genderqueer People: A Review of the Literature, The Journal of Sex Research, 2016. DOI: 10.1080/00224499.2016.1142495)
  2. Fifteen states ban transgender exclusions or denial by health insurers. (http://abcnews.go.com/US/wireStory/delaware-prohibits-limits-transgender-health-coverage-37925365)
  3. Provision of full access to health care benefits is cost-effective (Padula et al., Journal of General Internal Medicine DOI: 10.1007/s11606-015-3529-6, 2015).
  4. One-third of Fortune 500 companies provide transgender-inclusive health care coverage to employees (Human Rights Campaign Foundation Corporate Equality Index Rating American Workplaces on Lesbian, Gay, Bisexual and Transgender Equality http://hrc-assets.s3-website-us-east-1.amazonaws.com//files/documents/CEI-2015-rev.pdf)
  5. A number of studies confirm improved health and wellbeing post-transition (for example, Colton Maier, et al., The Effects of Hormonal Gender Affirmation Treatment on Mental Health in Female-to-Male Transsexuals. Journal of Gay & Lesbian Mental Health, 15: 281-2992011 and Olson KR et al., Mental Health of Transgender Children Who Are Supported in Their Identities. Pediatrics 2016;137(3):e20153223).
  6. Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People, The World Professional Association for Transgender Health, Version 7 http://www.wpath.org/site_page.cfm?pk_association_webpage_menu=1351&pk_association_webpage=3926