Students at the University of Maryland, College Park could have the cost of sex-change surgery covered by their health insurance next school year, joining a nationwide trend of private- and public-sector employers offering the benefit.
Insurance firms vying to cover the roughly 3,100 students who use the university health plan have been asked to structure proposals to cover sex reassignment surgery. The university expects to choose an insurance provider for the 2014-2015 school year this month.
Transgender-rights advocates say that because surgical gender reassignment is so rare, offering the benefit comes with minimal cost and could be a powerful recruitment and retention tool.
"Even just the possibility that students could obtain these services goes a long way toward providing a welcoming campus," said Joe Ehrenkrantz, the Student Government Association's diversity director.
Fifty universities across the nation and hundreds of Fortune 500 companies cover sex reassignment surgery — a trend that gathered steam in the past decade amid a growing acceptance of lesbian, gay, bisexual and transgender people in the U.S.
That acceptance, bolstered by changes including the legalization of same-sex marriage in more states, set the stage for college students to ask for the surgery coverage, said Anand Kalra, of the Transgender Law Center in Oakland, Calif.
"Historically, people have been trying to make things work in the gender they were assigned at birth, but more and more we're seeing people being able to come out younger," Kalra said.
But whether the University of Maryland decides to offer the coverage depends on how much it would add to premiums paid by all students on the plan, said Sacared Bodison, director of the university's Health Center. She expects it to add about $12 to $15 to the current premium of $1,363 a year, an increase of about 1 percent.
If the bids from insurers come in significantly higher, Bodison said, she would seek student input. The idea to explore offering the coverage, she said, was "really instigated by students."
Mykell Hatcher-McLarin, a senior from Baltimore who was born female but identifies as male, started an online fundraiser and is saving from a part-time campus job to pay out of pocket for chest masculinization surgery. The procedure is expected to cost at least $7,000.
"You see yourself in a certain way and your physical self doesn't match up with it, and there's nothing you can do but get surgery," said Hatcher-McLarin, who is on his mother's health care plan, which doesn't cover the surgery. "It's something that I want for myself but it's also something that I need."
Hatcher-McLarin, who has advocated for transgender-friendly policies on campus, said he plans to use a Maryland-based surgeon who doesn't take insurance, but that many of his transgender friends would like to get their operations done by a popular surgeon in Florida who takes all types of insurance.
Hatcher-McLarin, 21, said the university has become more accepting of transgender students since he came out two years ago. But he expected that adding the coverage would stir some opposition on campus. He pointed to a recent decision to offer mixed-gender housing on campus for students who prefer to live with the sex with which they identify or with friends of a different gender.
"There's already a conversation around exclusive housing and making exceptions for transgender people, so I'm confident it'll come up," Hatcher-McLarin said.
The university does not track how many students on campus identify as transgender and could not estimate how many would take advantage of the benefit. The Transgender Law Center estimates 2 percent to 5 percent of the general population is transgender to some degree, though the percentage of people who undergo surgical transition is much smaller.
For the University of Maryland, College Park, several recent measures were aimed at making transgender students feel more welcome on campus. The university already covers hormone therapy for transgender students under its health insurance plan, and the University System of Maryland last year added "gender identity or expression" to its anti-discrimination policy.
Ehrenkrantz said advocates on campus were encouraged by studying what other universities were doing with transgender health benefits.
Fifty universities — none in Maryland — currently cover sex reassignment surgery, including Yale, Northwestern, American and Harvard, according to Campus Pride, an advocacy group that tracks the issue. Another 19, including UMCP, cover hormone therapy.
"When people don't have proper coverage, sometimes they turn to self-medication or self-harm as ways to cope," said Nick Sakurai, associate director of the LGBT Equity Center at College Park.
"Surgical transition is not something that every trans person is interested in having, or needs to have, but I think for those that need that access, it can be an issue of quality of life. It can be an issue of not having depression, not having anxiety," he said.
It won't be clear until university officials review the bids what aspects of sex reassignment surgery would be covered. Officials asked insurance companies for proposals that would cover surgery costs up to $100,000.
Kalra said insurers often use adding transgender coverage as a way to increase premiums, but he said that was based on "faulty logic" because so few people take advantage of the benefit.
"We end up with a situation that makes it look like transgender students, in this case, are costing 'everyone else' more money, when that's really not the case at all," he said.
The amount that it can add to the premium can vary widely based on what's covered, if there is a co-pay and other factors, said James R. Napoli, an attorney for the American Benefits Council, a group that lobbies for benefits legislation favorable to employers. He did not have information on how much adding such coverage typically adds to a plan.
"It certainly is going to add to the general cost of the plan," he said. "Whether that cost is then borne by the participants on the plan, there's a lot of factors that go into that."
But more are adding the coverage, Napoli said. "Employers are wanting to have the appearance of being more inclusive."
No Fortune 500 companies offered coverage specific to transgender people in 2002, when the Human Rights Campaign began tracking the issue, said Deena Fidas, who directs the workplace equality program for the gay-rights group. Instead, it was often listed among the exclusions alongside cosmetic procedures, she said.
In 2008, the American Medical Association passed a resolution endorsing employer health coverage of sex reassignment surgery.
By 2009, 49 companies tracked by the campaign offered transgender health benefits. Now, 340 of those firms offer transgender health benefits — about a quarter of all Fortune 500, Fortune 1000 and large law firms in the country, Fidas said.
Five of the six large companies based in Maryland that the campaign tracks have added the benefit since 2012, including Lockheed Martin and Marriott International in Bethesda, Choice Hotels International in Silver Spring, and food services provider Sodexo Inc. in Gaithersburg. DLA Piper, a global law firm with a large presence in Baltimore, also offers the benefit.
"Not only has it opened up the conversation and the clear view on the part of insurance companies that there's a demand out there, it gave a lot of student groups a major arrow in their quiver when advocating for this because this conversation has become more mainstream," Fidas said. "There aren't a lot of companies left that are actively resistant. Some are slower than others."
Booz Allen Hamilton Inc., a defense and technology contracting firm with headquarters in Northern Virginia, has offered sex reassignment surgery coverage for its 23,000 employees for about five years. No aspect of the gender reassignment is denied, company officials said.
"When you include transgender benefits, it signals to other employees that this a firm that will care for its employees," said James Fisher, a Booz Allen spokesman. "So even though you may not use the benefit, it's a signal to a new hire about what kind of company this is, in terms of support for its employees."
For employees to get sex reassignment surgery covered, they typically must be diagnosed with gender identity disorder first, Fidas said. And some aspects of sex reassignment surgery that are still considered cosmetic — making an Adam's apple less prominent, or shifting the planes of the face — aren't covered under many insurance plans.
Transgender advocates also hope that the federal Affordable Care Act, which prevents insurers from denying coverage on the basis of pre-existing conditions, will bolster their case for expanded coverage.
State insurance commissioners in Oregon, California, Vermont, Colorado and Washington, D.C., have issued bulletins, citing Obamacare, that a person's gender identity cannot be a reason to deny them coverage.
"In the past, simply being transgender was frequently considered a pre-existing condition and a reason for people to be denied coverage or be charged higher premiums," said Kellan Baker, associate director of the LGBT Research and Communications Project at the Center for American Progress, a liberal think-tank.
"There is a lot of hope and expectation that things will get better for transgender people as the Affordable Care Act continues to roll out and we have this national conversation," Baker said.