With Caitlyn Jenner’s big reveal in recent months, there’s been a lot media attention regarding her transformation and her life as a transgender woman. Though her story’s been covered by everyone from Diane Sawyer and Vanity Fair, to CNN and Fox News, there’s been little coverage about Jenner’s experience with insurance matters, an issue that many transgender men and women struggle with daily.
In a recent article with CNN, Lourdes Ashley Hunter, national director of the Trans Women of Color Collective, discussed how there’s still a lot that needs to be done for the transgender community. In regard to Jenner, Hunter said the following:
“Her celebrity status is great for visibility, but it can and will be used as a distraction from the lived experiences of trans folk who continue to battle discrimination when accessing basic needs such as housing, employment, education and health care.”
Although the technical description of an insurance agent is “a person employed to sell insurance products,” it’s my belief that it’s also an agent’s job to educate his or her clients on the products available and best suited to their client’s need.
Whether those products are health, life, long-term care or disability insurance, it’s important than an agent is able to adequately explain everything from coverage and premiums to what can be expected from the application and underwriting process – even if a client is transgender.
For clients whose medical and psychological histories are extra sensitive, it’s equally crucial that agents are aware of the tools and resources available, so that clients are ensured a safe, positive experience.
Because many agents haven’t written disability insurance for a transgender client, I asked two major DI carriers to provide some insight to the underwriting process in order to both educate and familiarize agents with the process of writing DI coverage on a transgender client. Please note that each carrier’s response is slightly different, meaning that it’s up to the agent to find the appropriate carrier for his or her client.
We would consider transgender clients the same as any other client coming in for coverage based on their particular medical history. With any client, if there is surgery planned, but not yet performed, we would in general postpone consideration until following the surgery, release from care and return to work full-time without restrictions.
Post-surgery consideration would be based on any residual symptoms or problems as indicated in follow-up.
Policies will be issued based on the gender the proposed insured has indicated on the application
For underwriting purposes we underwrite based on the applicant’s gender at birth.
During the underwriting process we want to make sure that they have stable employment, no associated psychiatric disorders, or drug and alcohol history. If untreated and all looks favorable, we may consider with just a gender re-assignment exclusion. However if gender reassignment therapy is planned or contemplated, treated with or without hormone replacement therapy, we would postpone just as we would with any pending surgery. The surgery would need to be completed and the applicant would need to have returned to work on a full-time basis without residuals for consideration of coverage.
If therapy was partially completed with no plan to complete, treated with or without hormone replacement therapy, we would typically postpone coverage for the first 3 years and after 3 years may consider with a limited benefit period, extra premium and exclusion of gender re-assignment.
If therapy procedures have been completed, without complications, treated with or without hormone replacement therapy, we would also postpone for the first 3 years, and after 3 years we may potentially consider with a limited benefit period, extra premium, and exclusion of gender re-assignment.
We most likely would not offer FPO with these cases and there is a high potential for a mental disorder exclusion due to the psychological component that goes along with the decision for gender reassignment.
Some jurisdictions have regulations and special laws, so each case would need to be reviewed with our legal for input to determine the appropriate underwriting outcome.
For any clients who feel uncomfortable discussing their medical history with their agent, regardless of whether or not they’re transgender, it’s helpful to suggest a telephone application, often referred to as a TeleApp. A TeleApp is a private phone interview where medical information is gathered by a professional interviewer from the insurance carrier (not a third-party vendor). Clients are able to schedule their interview on their own time and the process eliminates the need for agents to ask medical questions.
If you are unable to assist or provide guidance to a transgender client, or if you have more healthcare- or law-related questions, here is a list of LGBT organizations that provide legal advocacy or direct-client services to LGBT community members:
- The World Professional Association for Transgender Health (http://www.wpath.org/)
- The Center of Excellence for Transgender Health (http://transhealth.ucsf.edu/)
- The National Center for Trans Equality (http://transequality.org)
- Forge-Forward (http://forge-forward.org)
- The LGBT Medical Association (http://glma.org).
Here are some terms and definitions that you might find helpful when working with a transgender client. These definitions were taken directly from the Gay & Lesbian Alliance Against Defamation (GLAAD) Media Reference Guide.
Transgender (adj.) – An umbrella term for people whose gender identity and/or gender expression differs from what is typically associated with the sex they were assigned at birth. People under the transgender umbrella may describe themselves using one or more of a wide variety of terms – including transgender. Some of those terms are defined below. Use the descriptive term preferred by the individual. Many transgender people are prescribed hormones by their doctors to change their bodies. Some undergo surgery as well. But not all transgender people can or will take those steps, and a transgender identity is not dependent upon medical procedures.
Transgender man – People who were assigned female at birth but identify and live as a man may use this term to describe themselves. They may shorten it to trans man. (Note: trans man, not “transman.”) Some may also use FTM, an abbreviation for female-to-male. Some may prefer to simply be called men, without any modifier. It is best to ask which term an individual prefers.
Transgender woman – People who were assigned male at birth but identify and live as a woman may use this term to describe themselves. They may shorten to trans woman. (Note: trans woman, not “transwoman.”) Some may also use MTF, an abbreviation for male-to-female. Some may prefer to simply be called women, without any modifier. It is best to ask which term an individual prefers.
Transition – Altering one’s birth sex is not a one-step procedure; it is a complex process that occurs over a long period of time. Transition includes some or all of the following personal, medical, and legal steps: telling one’s family, friends, and co-workers; using a different name and new pronouns; dressing differently; changing one’s name and/or sex on legal documents; hormone therapy; and possibly (though not always) one or more types of surgery. The exact steps involved in transition vary from person to person. Avoid the phrase “sex change.”
Sex Reassignment Surgery (SRS) – Refers to doctor-supervised surgical interventions, and is only one small part of transition (see transition above). Avoid the phrase “sex change operation.” Do not refer to someone as being “pre-op” or “post-op.” Not all transgender people choose to, or can afford to, undergo medical surgeries.
As always, the Disability Insurance Sales team is here to help answer your questions, find appropriate carriers and assist with case design. Contact us!