Miami Beach transgender healthcare memo

8/12/2019 Miami Beach transgender healthcare memo

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i\u1 lAlr,'i t&f ACFjCity oI Miomi Beoch, I /00 Ccnveniion Cenier Drive, Miomi Beoch, Ft 33139, www. miomibeochfl.gov

COMMISSION MEMORANDUMMayor Philip Levine and Members the C Commission

City Manager Jimmy L. MoralesJune 11, 2014

SUBJECT: DiscussionRegardinglncludi Transgender Health Care lnsuranceCoverage as a Benefit of Employment in Fiscal Year (FY) 2O1N'15Backqroundln 201 3, the City of Miami Beach self-submitted its application for a Municipal Equalitylndex Score and earned the maximum number of points available, 100; the only City inFlorida to merit the distinction with Tampa coming in a distant second with 89 points.The Equality Federation lnstitute of the Human Rights Campaign Foundation, whichawards the Municipal Equality lndex Score, has announced that a requirement in 2014 istransgender-inclusive health care benefits.Anticipated lncrease in Health Care lnsurance Premiums for Benefit Plan Year2014t15The City of Miami Beach benefits consultant, Gallagher Benefit Services (Gallagher), isprolecting that costs for the current levels of health care coverage provided by the City'splans will increase by 7.5o/o in fiscal and plan years 2014115 irrespective of therecommendation to add transgender health care coverage. The projection is based thecurrent national inflation trend of a plan's total cost of 8% and the current cost of theCity's plans. As the costs associated with the City's medical plans are running lowerthan the national trend, the projected increase for the upcoming plan year is alsopredicted to be lower.Benefits Associated With lncludinq Transqender Health Care nsurance Goveraqeas a Benefit of EmplovmentA September 201 3, survey of employers done by Jody L. Herman, Ph.D., Manager ofTransgender Research at the Williams lnstitute, University of California, School of Law,found that employers reported very low costs, if any, from adding transition-relatedcoverage to their health benefits plans or from actual utilization of the benefit after it wasadded.The goal of her study was to identify the number of surgeries and their related costs.The study was limited to US residents treated in the country. During this time period,1,170 transsexuals underwent surgery. At the time of her study, nationally, the averagecost for male to female surgery was $10,400 and the average cost for female to malesurgery was $17,000. These figures are based on 740 male to female surgeries and 430female to male surgeries, providing an average combined cost of $12,900 per surgery.

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Commission MemorandumDiscussion Regarding lncluding Transgender Health Care lnsurance Coverage as a Benefit of Employment in Fiscal Year(FY) 2014t15June 1 1, 2013Page 2As a result, at the time she conducted her study, the actual cost impact to providetransgender health insurance coverage benefits could be projected at $.173 per year,per participant at a national level. Of this cost, $.08 or more could be contributed toservices currently covered by many health care plans such as hormone therapy, doctoroffice visits and psychological therapies resulting in a total impact to health care plancosts of $.093 per year per participant.Employers who participated in her survey reported that providing transition-relatedhealth care coverage benefited them in a variety of ways. They reported that theyprovided coverage in order to: make them competitive as an employer within theirindustries and help them with the recruitment and retention of their employees; reflecttheir corporate values, including equality and fairness; provide for the healthcare needsof their employees and improve employee satisfaction and morale; and demonstratetheir commitment to inclusion and diversity.Via LTC 174-2014 (attached) on May 23, 2014, the Administration recommended thatbased on all the information at hand the City include transgender health care benefits inits self-funded medical plans effective with the new plan year.Cost of Transqender BenefitsThe city and county of San Francisco were among the first to include transgender healthbenefits, as a pilot program, in their self-funded health insurance coverage plans. Theprogram was designed to collect actuarial data related to the actual cost of coverage fortransgender medical benefits. The program began by including a one year enrollmentrequirement with individual coverage capped at $50,000. (The Patient Protection andAffordable Care Act of 2010 eliminated all coverage caps.) This benefit was based onsimilar coverage provided by the Canadian province of British Columbia. Using anestimate of 35 eligible plan members, they increased their employees' and retirees'monthly premium by $t.ZO per month. Between July 2001 and July 2004, the plancollected $4.3 million in additional premiums; however, the plan incurred only sevensurgical claims for a total payout of $156,000.ln 2004, the one year waiting period was eliminated and the individual coverage cap wasraised to $75,000. Additionally, the benefit became available through the city and countyHMO plans which until then had only covered hormone and psychological therapies.Even with the elimination of the waiting period, an increase in their medical plan'scoverage maximum and the addition of surgical coverage through their fully insuredHMO plans, the employees'and retirees'premiums were reduced from $1.70 to $1.16per month. Between July 2001 and August 2005, the city and county had collected $5.6million in additional premium and paid out $183,000 for 1 1 claims. Due to the low costimpact to the city's and county's medical plans, both self-funded and fully insured, theadditional monthly premium charged to employees and retirees was eliminated.Additionally, cost data has led the HMOs to no longer separately rate the transgenderbenefit, and the fully insured HMO plans are now treating it as they do any other medicalprocedure.City staff asked Gallagher to provide an actuarial cost of adding transition-relatedcoverage to the plans offered by the City. Three key areas were identified for coverage,hormone therapy, psychological therapy and surgery (those surgeries deemed medically

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Letter to CommissionTransgsnder Health lnsurance Benef itsl\iiay 23,2014Page 3Gost of Transqender BenefitsThe city and county of San Francisco were among the first to include transgender healthbenefits, as a pilot program, in their self-funded health insurance coverage plans. Theprogram was designed to collect actuariai data related to the actual cost of coverage fortransgender medical benefits. The program began by including a one year enrolimentrequirement with individual coverage capped at $50,000. rhis benefit was based onsimilar coverage provided by the canadian province of British columbia. Using anestimate of 35 eligible plan members, they increased their employees' and reilrees'monthly premium by $1 .70 per month. Between July 2001 and July 2004, the plancollected $4,3 million in additional premiums; however, the plan incurred only sevensurgical claims for a total payout of 9156,000.ln 2004, the one year waiting period was eliminated and the individual coverage cap wasraised to $75,000. Additionally, the benefit became available through the city and countyHMo plans which until then had only covered hormone and psychological therapies.Even with the elimination of the waiting period, an increase in their medical plan'scoverage maximum and the addition of surgical coverage through their fully insuredHMO plans, the employees' and retirees' premium was reduced from $,1 .70 to 91.16 permonth. Between July 2001 and August 2005, the city and county had collected 95.6million in additional premium and paid out $183,000 for 11 claims. Due to the low costimpact to the city's and county's medical plans, both self-funded and fully insured, theadditional monthly premium charged to employees and retirees has been eliminated.Additionally, cost data has led the HMos to no longer separately rate the transgenderbenefit, and the fully insured HMo plans are now treating it as they do any other medicalprocedure.The most recent study regarding the cost of these benefits was conducted from 2001through 2008 by Dr. Mary Ann Horton, who is an active diversity advocate, leader, andresearcher and has been recognized for her contributions in creating equality in theworkplace for lransgender, bisexual, lesbian and gay individuals. The goal of her studywas to identify the number of surgeries and their related costs. The study was limited toUS residents treated in the country. During this time period, 1,170 transsexualsunderwent surgery. At the time of her study, nationally, the average cost for male tofemale surgery was $10,400 and the average cost for female to male surgery was$17,000. These figures are based on 740 male to female surgeries and 430 female tomale surgeries, providing an average combined cost of g12,g0O per surgery.As a result, at the time she conducted her study, the actual cost impact to providetransgender health insurance coverage benefits could be projected at $.173 per year,per participant at a national level. of this cost, $.08 or more could be contributed toservices currently covered by many health care plans such as hormone therapy, doctoroffice visits and psychological therapies resulting in a total impact to health care plancosts of $.093 per year per participant.The City's benefits consultant, Gallagher Benefit Services (Gallagher), has determinedthat the addition of transgender benefits to the City's medical health insurance planswould not result in a significant cost to the City as the majority of services recommendedby WPATH are currently covered benefits under the plan. Additionally, the relatively lowcost of the reassignment surgery, in addition to the low prevalence of those seeking it,would have a minimal cost impact.

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Letter to CommissionTransgender Health lnsurance Bon6fitsMay 23,2014Page 4RecommendationBased on the benefits associated with providing the coverage, the Gounty and City ofSan Francisco's experience and Gallagher's projections, it is recommended that the Cityinclude the coverage in its self-funded medical plans effective in the new plan year,which is scheduled to begin October 1,2014.If you have any questions or need additional information, please do not hesitate to reachout to me.

JLM/KGB/SC-T

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Documents

Miami Beach transgender healthcare memo