“The times they are a-changing”... the words penned by Bob Dylan couldn’t be truer of the insured benefits landscape today.
While there have been changes on many fronts, it has been particularly visible in the area of inclusion regarding benefits to employees. Driven in part, by global benefits frameworks that encourage this at multinational firms and progressive Indian firms and supported in turn by a welcoming millennial workforce – we now see more benefits changes in India that address openness and inclusion and one key sector in focus has been the LGBTQ community.
While a lot has been initiated, a lot more needs to be done.
How Are Firms Making These Changes?
Insured benefits to the LGBTQ employee workforce are largely distinguished by the medical insurance benefits that apply to this group – since life and accident benefits apply to them in equal measure anyway (like any other employee group).
The primary change we see employers adopting is the recognition of long-term same-sex partners as part of the covered family unit. In many ways, this is a key change as it underscores the right of this section of the workforce, to provide health security for their long-term partners. This is even more progressive given that same-sex marriages are yet to be ratified in India and only about 25 countries recognize same-sex marriages today. This has been a very progressive approach as in our experience, many countries are yet to address benefit changes to this community adequately. It was only in 2015, for instance, that same-sex couples were given equal marriage rights in the USA. Closer home, in Hong Kong, for example, it is only recently in 2018 that the courts required the government to provide spousal benefits on visa rules to same-sex partners. Seen in that context, this has been a progressive change.
The secondary change that we see firms adopting is the ability to address gender dysphoria and allow for gender affirmation or gender change surgeries to be covered under benefit plans. In many plans, these are now being included as an additional coverage item within the inpatient list of covered treatments and within the existing employee, the family sum insured limits. While this may not cover costs in entirety, this is a step I believe in the right direction.
What Challenges Do Firms Face in This Area?
We see the following key challenges and opportunities beginning to take shape as firms introduce these benefits - that will also impact how these benefits evolve.
So Why Should Firms Consider These Changes?
In many of the firms adopting these benefit changes, actual utilization of these benefits has been low, allowing for insurers to price them at relatively low cost. This is possible since insurers price for benefits, largely on past year claims experience (which in turn is low based on data trends that were seen).
For example, utilization of gender affirmation surgeries has not been more than one or two per 100,000 employees covered. So, while actual claim experience could be higher at a smaller firm, given that this is a benefit that employees voluntarily opt to utilize, this trend may stabilize over time even as these employers would attract employees desirous of these benefits. Similarly, where same-sex partners are encouraged, barring a few firms, actual reporting of same-sex partner data under medical plan enrolment data has been low with relatively low impact on claims. However, as firms attract LGBTQ employees on account of these benefits, utilization trends may increase going ahead and insurers may need to review the impact on an ongoing basis.
So why then, should firms adopt these benefits?
In my opinion, the primary driver for including these changes should not be the relatively low cost to make this change but the intention to attract resources from this talented community in future who would prefer to be with an employer that does not discriminate. It also frames the employer image clearly, as one that encourages an alternate point of view and makes the workplace a tolerant one. In addition, for firms aiming to attract a global clientele, a benefits program that is inclusive in design allows for a meeting of minds and cultures – All of these are very good reasons to make your benefit plan designs LGBTQ friendly.
Whilst these are not intended to be exhaustive – the road ahead for LGBTQ employee benefits has only just begun and I expect bringing inclusiveness in all aspects of benefits design will only gain steam in the days ahead.
As quoted by Bob Dylan – these trends seem to be on the rise, and we have every reason look forward to a more inclusive view on benefits for our LGBTQ employee colleagues.‘The line it is drawn, the curse it is cast, the slow one now, Will later be fast As the present now, Will later be past - The order is rapidly fadin'
Ashley DSilva – Executive Vice President & Practice Head – Health & Benefits
Ashley is the EVP & Practice Head - Health & Benefits for Anviti Insurance Brokers in India. He has over 19 years’ experience in the employee health & benefits on a wide range of issues including design, financing and implementation of insured employee benefits programs as well as benefit consulting projects like benefit integration studies and implementation, risk mitigation projects, benchmarking projects and benefit audits.