How do I know if I'm covered?

April 3, 2014 7:20 AM

I am a trans woman. Recently, I received a job offer from a private higher education institution in New York City. I would really like to accept the job, but repeated conversations with the individual who recruited me—who has been asking questions on my behalf to the institution's Human Resources department—have left me unsure whether or not their health insurance will cover trans-related care. How do I get this information? Can I get this information?

In my experience, many health insurance plans have restrictions and coverage exceptions when it comes to trans-related care. Not just for "surgery" (which isn't relevant to me at the moment) but for hormone replacement therapy, doctor's visits related to HRT, and mental health care related to transition, etc.—all of which would be very expensive for me to pay for out-of-pocket. I don't feel comfortable accepting the job until I know whether or not there are such restrictions with this employer's plan. For other recent job offers, I've had success in simply asking HR representatives for a copy of the organization's certificate of coverage, which generally has enough information for me to make an informed decision.

With the institution in question, however, things have been more difficult. I asked the individual who recruited me for the certificate of coverage, and they asked HR on my behalf, and HR flatly refused. Since then, my request has been escalated several levels up the hierarchy, with the director of the department who wants to hire me talking to the director of HR—but I still haven't been allowed to see the document. They've now put me directly in contact with someone from HR, who I'm scheduled to have a phone conversation with soon—but given HR's unwillingness to help anyone else, I'm not optimistic that they'll want to help me when I ask on my own.

The individual who recruited me for this job knows I'm trans, but hasn't disclosed that to any of the other parties involved. They did ask the HR department questions about the institution's trans-related care, at my request—questions which HR apparently refused to answer—but without ever making specific reference to me.

I understand that it would be irresponsible for HR to "promise" that their insurance would cover whatever medical treatment. Still, it's difficult for me to accept a job not knowing whether I might be on the hook for hundreds of dollars worth of medical treatment each month for HRT and related visits to the doctor. (I am privileged in that I'm confident I could find a way to pay for this treatment on my own if I needed to, but that extra cost definitely weighs into whether or not I want to take the job.)

So my questions are: Do I have any recourse? Is there some magical sequence of words I can say that will make someone in HR want to give me any kind of useful information about trans-related care under their health coverage? Would this be something worth contacting an advocacy organization about? Is it paranoid to assume that health coverage at such an institution might have specific exclusions for trans-related care? Am I even approaching this situation the right way? At this point, I just feel awful—I am bewildered and frustrated by the whole thing and don't really know where to turn or what to do.

Other context, in case it's relevant: I live in New York City. I'm still at the beginning of my transition, and right now I'm only "out" to a few friends and family. I am seeing a therapist and I am under a doctor's care for hormone replacement therapy.

Here's a throwaway e-mail, if you'd like to contact me privately: [e-mail]

posted by anonymous to Work & Money (21 answers total)

I work in a (public) institution of higher education and have been involved in hiring. If there were a candidate I wanted to hire, and they were considering not taking the job because our HR department refused to release information about our health insurance policies -- in other words, if my institution were unwilling to tell you the exact terms of the position we were offering -- I would consider it my job to shout at HR until you got what you needed, because I wouldn't want to lose someone I wanted to hire over that issue.

So I think you need to make it very clear to the person who's recruiting you that this is a critical issue -- that you want to accept the job but you can't do it unless you know what the terms are (you wouldn't accept the job if they refused to tell you the salary, right?) The internal recruiter should be the one stepping up and battling HR, not you.
posted by escabeche at 7:28 AM on April 3, 2014 [6 favorites]

Can you contact the institution's LGBT Campus Center or similar? As a prospective staff member, I would suggest you go to the Employee Assistance Program or ombuds equivalent, except that you're not actually employed by the school yet. So if you go through the LGBT Center, which typically caters to students but may have some links for faculty and staff, maybe they can help you.

In my experience, LGBT centers and their like have been perfectly willing to go against the backlog of bureaucracy. That's kind of their reason for being :)
posted by Madamina at 7:28 AM on April 3, 2014 [5 favorites]

"I'd like to see the certificate of coverage, and I'd rather not discuss my medical history with you. Health insurance is a huge part of the compensation package. You wouldn't tell me, 'Sure, we'll pay you, um, between $20,000 and $200,000 a year, but if you send me your mortgage, I'll tell you whether you'll be making enough money to cover it,' would you?"

You are not being paranoid in wanting to know how your medical issues will affect your overall total compensation.
posted by Etrigan at 7:30 AM on April 3, 2014 [25 favorites]

Two bits of information which you might ask a mod to add to the thread that could help get you the information you need without going through HR:

1) What is the institution? You could refer to it in a coded way if you are worried about anonymity -- i.e. "It has a similar name to a South American country."

2) What is the health insurance company, and what are the names of the plans they offer?
posted by Rock Steady at 7:39 AM on April 3, 2014

Another option is to accept the position and then resign if the health coverage is insufficient.

This would obviously be a last resort sort of situation and I'm also not sure I'd even want to work for a company unwilling to tell me the terms of my employment agreement before I agreed to it, but if the job is otherwise very attractive to you, this is an option.
posted by toomuchpete at 7:41 AM on April 3, 2014

Couldn't you ask to review their plan's Schedule of Benefits or Benefits handbook as a part of understanding what you would be getting in regards to health insurance? If nothing else, you deserve to know what you're paying for health insurance in comparison to your current plan. It's not unreasonable to want to know if more or less is being covered for more or less money.

I don't have your specific issues, but this is something if I ever change jobs, I am going to specifically ask for when an offer is made.
posted by zizzle at 7:45 AM on April 3, 2014 [5 favorites]

Since you're already scheduled to talk to HR, you should ask them why they're refusing to give you the certificate of coverage, and see if you can work around that. For instance, you could see it under an NDA if they're worried about making it public. Unless there are personal reasons you'd prefer not to tell the HR person that you're trans during that conversation, disclosing that may help -- first, it may help overcome the HR person's objections because you have something reasonable and concrete you're looking for that will directly affect your health, and second, they may be worried about being accused of discriminating against you if they refuse to help.
posted by chickenmagazine at 8:04 AM on April 3, 2014 [1 favorite]

I would modify Etrigan's script:

"I'd like to see the certificate of coverage, and prefer not to discuss my medical history with you. Health insurance is part of the compensation package, and I cannot accept an offer without knowing the full details of the compensation offered."
posted by insectosaurus at 8:42 AM on April 3, 2014 [15 favorites]

The simple fact that they refused to say when asked would make me very very wary. I would not accept the position until you have positive, in writing confirmation that your health needs will be covered. If they can't/won't then I'd walk away and call this a bullet dodged. You don't want to work for a company with an HR department like that. Even if you do get the medical coverage information, I would still think on whether you want to work someplace that allows that sort of behaviour from their HR department.
posted by PuppetMcSockerson at 8:50 AM on April 3, 2014 [5 favorites]

I suggest that you contact the TLDF. They may be able to provide you with helpful advice or point you to a good resource.
posted by prefpara at 9:45 AM on April 3, 2014

I might be missing something, but can you just do an end run around HR? Ask whoever is hiring you to print their own plan documents (presumably the same plan you'd be getting and containing none of their personal information). Those documents would also have the contact and plan info you'd need to contact the insurance company yourself with particular questions.

They wouldn't even need to give you the documents, just the plan or group ID and the contact info for the insurance provider and you could call with questions.
posted by pseudonick at 9:45 AM on April 3, 2014 [2 favorites]

Sorry, I should have said more than just "contact TLDF." I don't think you can necessarily tell whether you'll be fully covered just by reviewing the policy. So getting your hands on the policy may not get you all the way to your goal. The TLDF may be able to help you connect with resources that can help you get the policy and understand it once you have it. I've worked on a case involving a policy that was interpreted to exclude a certain service for a trans individual, and it was not obvious that the policy as written would be interpreted that way. This is a question that may ultimately require help from an attorney.
posted by prefpara at 9:49 AM on April 3, 2014

It sounds like you want the plan booklet not the certificate of coverage. The certificate of coverage is a one page thing that just states you have health insurance. I'm not surprised they won't give a certificate of coverage, you aren't covered by them.

Ask for the full plan booklet and plan summary.
posted by magnetsphere at 10:09 AM on April 3, 2014 [4 favorites]

pseudonick makes a good point - if the hiring manager has the same insurance they'd offer you, can they show you their booklet and coverage information? When my fiance got his job offer, his boss sent him a PDF of his own plan info.
posted by radioamy at 10:37 AM on April 3, 2014

In terms of not wanting to give you documents, the HR department probably has a long and unpleasant history of job offerees being provided full health care coverage documents, misreading them, and then after taking the job insisting that they were covered for things that were in fact not covered or not covered to the extent they wished.

By contrast, a big private university in NYC will have dozens of trans employees and the benefits gurus in HR will be thoroughly familiar with which typical healthcare outlays are covered and not covered. Big university will also be fully covered by New York City and New York State human rights laws which are as protective as can be of LGBT people.

You could consider being more blunt -- ask your hiring manager to ask HR "Candidate is transitioning gender under medical supervision. Can you advise me how our health plan covers non-surgical healthcare associated with that?"
posted by MattD at 10:42 AM on April 3, 2014

Is it a union job? You might have to go to the union for that info because health care is probably via them. Be aware that one public employer can have employees with different unions who have different medical plans.
posted by fshgrl at 10:57 AM on April 3, 2014

Actually, depending on the company/companies who cover the employees, an employee may have the option to choose one of several plans with different insurers.

So I'd agree with zizzle -- if you know which plan you might have access to, or the group number or whatever, you could read the booklet (or Google it, which is what I've had to do re: figuring out some maternity benefits lately) and then contact the plan directly.
posted by Madamina at 11:12 AM on April 3, 2014

If the employer has a large, self-funded employee health plan - the document you're looking for is formally known as a Summary Plan Description or SPD. I work at a large, household name insurance company and my job is to write these things for self-insured groups.

It's possible they don't have a current SPD. Per the laws which govern these types of plans (ERISA), the responsibility to prepare and issue the SPD is on the employer and not the insurance company. My company offers to do the drafting for the employer, but it's up to them to approve and distribute the final document to their employees. You would be surprised by how many companies just don't have one or what they do have is out of date.

They are supposed to have one by law, and provide a copy to any EMPLOYEE upon request. But they would only face penalties if an employee files a complaint with the appropriate federal agency. Seeing as you're not an employee, those rights don't apply to you.

BUT - as others have said, the health plan is part of your compensation and you *should* have access to all the details regarding said compensation.
posted by thatguyjeff at 11:15 AM on April 3, 2014

Hey, if you reach out to me, I can put you in touch with the Transgender Law Center people who can run down what insurance is now required to cover for trans* people. Many of the previous exclusions have been specifically stricken, though there's still a lot of gaps.
posted by klangklangston at 2:50 PM on April 3, 2014

I work for a major university and the idea of anybody in HR treating any of the Evidence of Coverage booklets (physical or electronic) as somehow confidential seems utterly bizarre. A quick search indicates that many other institutions think along the same lines.

Nthing that you shouldn't accept any offer that doesn't include detailed information about what the health coverage includes.
posted by Lexica at 8:34 PM on April 3, 2014

I agree with everyone above. You're not looking for a certificate of coverage.

But I came to make a new suggestion. Don't assume, going into your conversation, that HR people have been difficult. For one thing, you only have your contact's word that she or he spoke to all those levels of HR. It sounds like there's been a big problem with communication -- a lot of people simply don't have the vocabulary of health insurance terms to have a substantive conversation about it.

Approach the HR person as someone who is there to solve this riddle and give you what you want. Don't assume that you're getting on the phone to have a big fight. This person may be your savior.

"Thank you so much for talking to me!" is a good way to start the conversation.
posted by vitabellosi at 9:56 AM on April 4, 2014 [2 favorites]