In 2015, the United States Supreme Court determined in Obergefell v. Hodges that same-sex couples have a Constitutional right to marry nationwide. Any business that provides benefits based on marriage to an employee's different-sex spouse must now provide marital benefits to an employee's same-sex spouse.

HRC’s annual review of summary plan documents via the Corporate Equality Index reveals gaps updating the definition of “spouse” for the purposes of defining eligible dependents across benefit plans.

Plans submitted in the 2016 survey included references to the “Defense of Marriage Act” (ruled unconstitutional in the United States v. Windsor in 2013) as well as language that would define a “spouse” as an opposite-sex spouse only. Such language is out of step with the current law, post-Windsor, and post-Obergefell, and should be updated to ensure clear access for all legally wed couples, both same and different-sex.

To receive credit, your facility must meet the following:

Have the health insurance contract definition of spouse include same-sex spouses as well as different-sex spouses AND the health insurance contract has the same requirements for same and different-sex spouses.. “Legally married spouse” (or variations of this) will also count.

Examples of definitions including same-sex spouses:

• Geisinger Health System clearly defines "legally married spouse" as an individual of the same or opposite gender.
• Memorial Sloan-Kettering Cancer Center outlines how same-sex and opposite-sex spouses are treated the same for benefits plan purposes.
• Legacy Emanuel Medical Center explicitly notes that eligible dependents include an employee's legal spouse (same or opposite sex).

Examples of same requirements for same and different-sex spouses:​

• Rush Health’s Benefits Guide includes dependents of same-sex spouses or domestic partners in its description of those eligible for medical coverage. The Guide also requires the same documentation to verify dependents of same-sex and different-sex spouses and domestic partners.
• Oregon Health & Science University’s Benefit Highlights Guide asks for the proof of relationship documentation for both same-sex and different-sex spouses and domestic partners.

To receive credit, your facility must:
Have the 2017 benefits documentation clearly indicate that unmarried domestic partners are eligible for healthcare benefits.

Resources:
Learn more about why HRC strongly recommends continued provision of domestic partner benefits.
See this piece from the HEI 2017 for more information.

Here are some examples of facilities that offer healthcare benefits to domestic partners:

• Planned Parenthood Gulf Coast's employee benefits guide states the benefits may be extended to domestic partners of employees.
• Oregon Health & Science University allows employees to cover domestic partners as eligible dependents for benefits.

Resources:

• Visit our page on FMLA-Equivalent Benefit for LGBT Workers to learn more about how these benefits affect LGBT employees.
• View our 2018 U.S. LGBTQ Paid Leave Survey report which reveals an urgent need for inclusive employer-paid family and medical leave.
• See the Movement Advancement Project’s Equality Map on Family Leave Laws to learn about the laws in your state.

Here are some examples of facilities that offer FMLA-equivalent benefits:

• ​​Planned Parenthood Southwest Ohio Region explicitly states that employees may take family/medical leave to care for domestic partners and children of their partners.
• Employees at Cedars-Sinai Medical Center are entitles to take leave to care for a domestic partner and their children.
• University of Washington Medical Center's FMLA policy includes domestic partners as eligible family members that employees may take leave for.
• Howard Brown Health Center allows employees to take FMLA to care for domestic partners and children.

Here are some examples of facilities that offer LGBTQ-inclusive bereavement leave:

• Arkansas Children's Hospital's bereavement policy names domestic partners as immediate family members of employees for them to take bereavement leave.
• Emma Pendleton Bradley Hospital includes domestic partners as family members that employees may take bereavement leave for.
• H. Lee Moffitt Cancer Center and Research Institute provides bereavement leave for employees in the event of a the death of their domestic partner.

To receive credit, your facility must:
Have equal health coverage for transgender individuals available in at least one firm-wide available plan without exclusion for medically necessary care that meets the following baseline criteria:

• Insurance contract explicitly affirms coverage
• Plan documentation is readily available to employees and clearly communicates inclusive insurance options to employees and their eligible dependents
• Benefits available to other employees must extend to transgender individuals. Where available for employees, the following benefits should all extend to transgender individuals, including for services related to transgender transition (e.g., medically necessary services related to sex reassignment):
  • Short term medical leave
  • Mental health benefits
  • Pharmaceutical coverage (e.g., for hormone replacement therapies)
  • Coverage for medical visits or laboratory services
  • Coverage for reconstructive surgical procedures related to sex reassignment

For the HEI, facilities must submit two different documents to validate and prove the availability of these benefits.

• The first document needed is your Summary Plan Documentation -- the contract your facility has with your insurer. This SPD will detail the various gender transition coverages available. So when an employee looks at their benefits package (and sees eligibility information, COBRA information, limitations, exclusions, etc), they would see that gender transition coverage is available.
• The second document needed is the Clinical Plan Bulletin (sometimes called a medical policy) provided by your insurer. This document describes the overall range of gender transition services provided by the insurer. You can look at this listing to see what transgender-related medical services your insurer offers (if any).
  • Please note that the services of the insurer does NOT mean your organization necessarily offers these services. Your organization’s SPD will describe what specific gender transition coverages you have opted into.

Resources:

• This section of the HEI 2019 articulates the importance of providing transgender-inclusive healthcare insurance
• We encourage you to review HRC’s Trans Toolkit for Employers for a wide range of resources and best practices for employer transgender inclusion. The Toolkit includes HRC’s best practice advice for implementing transgender-inclusive policies (including sample policies) and practices as well as guidance for implementing transgender-inclusive healthcare benefits.
• Visit our comprehensive resources page on transgender-inclusive benefits for employees and dependents to learn about businesses already addressing the discrimination faced by transgender employees, how to find out if your health insurance discriminates, and how to make health insurance plans transgender-inclusive, along with accompanying case studies.
• Read HRC’s White Paper on Transgender-Inclusive Health Care Coverage and the Corporate Equality Index.
• The WPATH Standards of Care are the most widely recognized standards of practice in transgender healthcare. The WPATH Standards of Care have been recognized by the American Medical Association, the American Psychological Association and the National Association of Social workers, as well as in numerous psychiatric textbooks.

Examples:

• Legacy Emanuel Medical Center's PacificSource Plan outlines surgical and non-surgical treatments for gender dysphoria that are covered by their plan.
• The University of Maryland Health Center's UnitedHealthcare Plan affirms coverage for transgender-related healthcare.
• Memorial Sloan-Kettering Cancer Center offers employees a variety of health plans that explicitly cover medically necessary health services for transgender employees.
• See page 22 of the City of New York's Summary Program Description for their Health Benefits Program. This SPD clearly indicates how psychotherapy, hormone therapy, and gender affirmation surgeries are covered under all of the health plans offered by the City

It is often said that when a person transitions gender, everyone around them transitions along with them. In other words, a workplace transition involves change not only for the employee but also for their manager, colleagues and clients.

Business leaders know the importance of proper planning, communication and training in implementing successful organizational change. A successful gender transition is no different. A little planning can go a long way to ensuring a successful outcome for all involved — the transitioning employee, managers, colleagues and clients/customers.

Gender transition guidelines, a written set of guidelines to manage an on-the-job gender transition, outline protocols for gender transitions that clearly delineate responsibilities and expectations of transitioning employees, their supervisors, colleagues and other staff.

Resources:

• Review HRC’s Template for Gender Transition Guidelines for best practices for transitioning employees, managers and HR representatives and more.
• See our page on workplace gender transition guidelines to learn more about organizational protocols for gender transitions that should include guidance on restroom and facilities access, dress code and internal recordkeeping that fully recognize an employee's full-time gender presentation and maximize privacy for the employee.
• Review HRC’s Sample Restroom Policy to better accommodate transgender employees.
• See the Guide to Restroom Access for Transgender Workers by the Department of Labor’s Occupational Safety and Health Administration which addresses why restroom access is a health and safety matter.
• See the Guidance Regarding the Employment of Transgender Individuals in the Federal Workplace from the Office of Personnel Management. This guidance would apply to all Veterans Health Administration facilities.

Here are some examples of gender transition guidelines:

• City of Hope's National Medical Center has established guidelines to support transgender employees during their transition.
• Seattle Children's Hospital developed a guide as a reference tool for employees that may be contemplating and planning their workplace gender transition.
• Children's Hospital of Pittsburgh of UPMC's gender transition guidelines provide a plan to support transitioning employees, their manager, co-workers, and Human Resources of respective roles, responsibilities, and expectations in the process.
• Brigham and Women's Faulkner Hospital designed a toolkit that addresses the needs and issues that arise in the workplace when a transgender employee transitions. This toolkit offers as a guide to support for employees during their transition.
• Gracie Square Hospital's gender transition guidelines serve to provide a safe and comfortable environment for transgender and gender non-conforming employees who transition on the job.

Resources:

• Visit our comprehensive page on LGBTQ employee groups to learn about the different types of groups organizations have, the objectives of such groups, see example established employee resource groups, and more information on establishing an employee group or expanding your existing group.

Examples:

• See Nationwide Children's Hospital's LGBT Employee Resource Group webpage.
• See Henry Ford Health System’s PRIDE group brochure.
• See Contra Costa Regional Medical Center’s LGBT Employee Resource Group flyer.

Examples:

• ContraCosta Regional Medical Center's flyer includes the facility's diversity statement specifically names and highlights LGBTQ diversity as part of its mission.
• This webpage for the Mount Sinai Office for Diversity and Inclusion lists out their areas of focus, which include the LGBTQ population.
• Learn more about the Diversity Equity & Inclusion Council at Cooley Dickinson Health Care on this page.
• The Diversity program at Thomas Jefferson University has some interesting programs to promote LGBT diversity.

Resources:

• See our page on self-identification of LGBTQ employees to learn more about asking these questions and why anonymity is so important to employees who disclose their LGBTQ status.
• See the Corporate Equality Index's document on collecting SOGI data from employees.
• Read the Williams Institute publication Best Practices for Asking Questions about Sexual Orientation to learn more about why collecting this data is important, what questions to ask, and how and where to ask them.
• If your hospital or health system uses Press Ganey for your Employee Engagement Surveys, Press Ganey now has new demographic measures for sex, gender identity and sexual orientation. You should contact your Account Manager to add SOGI options to your surveys. We encourage you to review the best practices listed above before determining your response options and we strongly discourage you from using the "transsexed" and "transitioning" response options to the question about sex.

Examples:

• After completing a Work Culture survey, Fenway Health asks employees about their sexual orientation, gender identity and sex assigned at birth.​
• Saint Barnabas Medical Center administered an anonymous survey to their staff which included questions on their staff's gender identity and sexual orientation.
• In their employee engagement survey, Whitman Walker makes sure to collect SOGI information on their staff.

Resources:

• Some example questions for this survey might be (but are not limited to):
  • Does this organization value differences in age, gender, sexual orientation, gender identity or expression, and race or ethnicity? Measure level of agreement and rating scale.
  • Are diverse people (differences in race, gender, age, religion, sexual orientation, gender identity etc.) treated fairly at this organization?
  • Do all staff members have an equal opportunity for promotion regardless of race, religion, gender, sexual orientation, age, ethnic background, national origin, or disability?
  • Have you personally witnessed or experienced discriminating behavior at work, on the basis of some diversity-related characteristic in the past twelve months?
  • Identify the type of discrimination that occurred, including sexual orientation and gender identity as an option.
  • For more example questions and a comprehensive review of the workplace climate for LGBTQ people, see our Degrees of Equality Report detailing how LGBTQ identity surfaces and unfolds in the workplace, and how organizations can identify and address opportunities to improve climate and drive up performance and retention.
• If your hospital or health system uses Press Ganey for your Employee Engagement Surveys, Press Ganey now has new evaluative measures for sex, gender identity and sexual orientation. You should contact your Account Manager to add SOGI options to your surveys.

Examples:

• NYC Health and Hospitals asked staff questions related to LGBTQ self-identification and distributed an LGBT Health Needs survey.
• Kaleida Health released a climate survey for employees to determine how inclusive their facilities are to the LGBTQ community.
• This anonymous LGBTQ climate survey helps Boston Children’s Hospital garner vital data to improve employees’ experiences, as well as patients and their families.

Examples:

• Buffalo General Medical Center under the Kaleida Health system offers a screenshot of its HRIS to show that is collects sexual orientation and gender identity information.
• Keck Medical Center of USC has an HRIS that captures gender identity information from their employees.

Resources:

Some LGBTQ holidays your facility might celebrate include (but are not limited to):

• International Transgender Day of Visibility
  Observed each year on March 31st to celebrate the courage it takes to live openly and authentically while also recognizing the leadership of transgender and gender nonconforming trail blazers who have led the charge in the fight for equality.
• LGBTQ Pride Month
  Occurs annually during the month of June (although Pride celebrations may be held during other times of the year). Pride is a time when many cities and towns host Pride parades, movie screenings, symposia, and more to celebrate LGBTQ history and identities.
• Celebrate Bisexuality Day
  Falls on September 23rd annually as a day to recognize and celebrate the bisexual community.
• LGBT History Month in October
  Celebrates the achievements of lesbian, gay, bisexual or transgender icons. The month provides role models, builds community and makes the civil rights statement about the LGBTQ community’s national and international contributions.
• National Coming Out Day
  Occurs on October 11th every year as a day to celebrate coming out as lesbian, gay, bisexual, transgender, queer or as an ally.
• Spirit Day
  Observed annually on October 16th where millions of people wear purple to stand against bullying and show their support for LGBTQ youth.
• Transgender Day of Remembrance
  Occurs annually on November 20th as an opportunity for communities to come together and mark the passing of transgender and gender-variant individuals—or those perceived to be transgender—who have been murdered because of hate.

Examples:

• NYC Health and Hospitals – North Central Bronx held an internal celebration before they attended New York City Pride.
• VA Robley Rex Medical Center’s internal ceremony to celebrate their Leader designation to celebrate Pride.
• View Anderson County Hospital’s internal event with cupcakes to celebrate LGBT History Month.
• Clinical staff at Crittenton Children’s Center created an interactive presentation at their “Dance to Your Own Music” event to celebrate LGBT History Month.
• Northwell Health celebrated National Coming Out Day while also promoting their employee resource group and HEI participation.

To receive credit, your facility must:
Demonstrate how hiring efforts are proactively LGBTQ inclusive. Simply having an employment non-discrimination statement that includes “sexual orientation” and “gender identity” posted on job descriptions or career website does not count for this criterion, however, it does count for publicly communicating you employment non-discrimination policy.

Resources:
Organizations can target potential LGBTQ employees in a variety of ways:

Job postings are sent to LGBTQ organizations and/or print/online LGBTQ publications

• For more information on LGBTQ-inclusive hiring and recruitment, visit our webpage detailin LGBTQ recruitment and LGBTQ-specific job sites.
• Northwell Health utilized an LGBTQ job search website to recruit for open positions.
• See an example of a LGBT job ad from the VHA.

Organization has hiring/recruitment brochure explicitly targeting LGBTQ people

• See Truman Medical Center’s brochure on their commitment to LGBT community, highlighting the LGBT employee benefits at their facility.
• VA Palo Alto Healthcare System has an LGBT specific employment brochure.
• Wm. Jennings Bryan Dorn VA Medical Center’s LGBT employment program also has an employment brochure that emphasizes their diversity and inclusion of LGBT employees.

Organization attends LGBTQ job fairs

• See our page on LGBTQ professional recruitment events to find recruitment or career events with a national focus. You can also reach out to your local LGBTQ community center to see if there is an LGBTQ job fair in your area.
• MetroHealth hosted a Transgender Job Fair at their facility to recruit prospective talent in northeast Ohio.

Note: We are looking for a senior/executive-level administrator at your organization.

The presence of visible LGBTQ employees in management communicates to the LGBTQ employees of your company that their company is open and accepting and enables LGBTQ employees to be open at work, which in turn improves their engagement and retention.

Resources:

• Check out HRC's "The Cost of the Closet and Rewards of Inclusion" report which finds that despite a changing social and legal landscape for LGBTQ people, still over half (53%) of LGBTQ workers nationwide hide who they are at work.