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For many transgender individuals, the decision to transition is monumental. But it’s also met with the mounting costs of medical procedures. Some of these costs are excluded by insurers, who consider certain procedures to be cosmetic.

On Monday, Starbucks announced its expanded health insurance plans to cover additional procedures, such as breast augmentation or facial feminization surgery, that have previously been classified as cosmetic. Starbucks has offered gender reassignment surgery for its employees since 2012, and has implemented its expanded coverage since October 2017, said Reggie Borges, a Starbucks spokesperson.

It will be the first company to work with the World Professional Association for Transgender Health and adapt the association’s standards of care into its health policies, according to the company’s statement.

“Starbucks has created supplemental coverage that overlays the coverage that the insurance companies allow to get the coverage up to the standards of care developed by WPATH,” said Borges.

Currently, 759 employers in the United States offer transgender-inclusive health care plans, according to the Human Rights Campaign. These plans do not have transgender exclusions, or provisions that narrow the scope of coverage for a trans person’s needs. Nineteen states and the District of Columbia also prohibit transgender exclusions from private insurance coverage.

“It’s really about removing exclusions, rather than offering something new,” said Ben Hudson, Jr., executive director of the Gender Health Center, a nonprofit that provides counseling services to the trans community.

Since 2017, the Office for Civil Rights, which operates within the Department of Health and Human Services, has mandated that transgender exclusions in most types of health insurance are prohibited. The mandate bans discrimination based on gender identity, although it does not require coverage of specific transition-related care, noted Out 2 Enroll, a national LGBTQ health care enrollment initiative.

“[Insurance] regulations are changing and these large companies are recognizing that this is medically necessary for trans folk. And anything medically necessary needs to be covered by health insurance,” said Hudson.

Hudson, who is a transgender man, believes Starbucks should not be lauded for its expanded policy. Instead, he said the policy is “obvious” and “about time.”

“It’s not about removing the word cosmetic,” Hudson said, noting the diverse needs of a person transitioning. “It’s never been cosmetic for trans folk. It’s always been about medical necessity.”

Transgender health organizations, like WPATH, have long advocated against calling certain surgical procedures cosmetic, although some insurers do exclude them as such, according to an analysis by Out 2 Enroll.

“These reconstructive procedures are not optional in any meaningful sense, but are understood to be medically necessary for the treatment of the diagnosed condition,” WPATH’s policy statement reads. “In some cases, such surgery is the only effective treatment for the condition, and for some people genital surgery is essential and life-saving.”

Arielle Gordon, a transgender communications director with GLAAD, says the policy expansion highlights the company’s willingness to listen to the health needs of its employees.

“As an LGBTQ advocate, it reminds me of the positive impact of increased visibility for the transgender community and makes me hopeful that other companies will follow Starbucks’ lead to provide comprehensive and inclusive health care plans for their transgender employees,” she said in an email.

Patients, when requesting coverage for procedures, must prove to health insurers their condition is medically necessary, through statements or referrals from medical professionals and a diagnosis of gender dysphoria.

If a patient has been denied coverage for a procedure like breast reduction surgery, they may have legal grounds to challenge it, according to Transcend Legal, a national legal organization that represents transgender individuals.

“In practice, however, many employers still do offer policies with exclusions of transition-related care in place,” said Mara Keisling, executive director of the National Center for Transgender Equality. “Transgender people still face considerable barriers to care — regardless of where they live or who they work for.”

Like Hudson, Keisling sees Starbucks’ new policy as part of a nationwide shift from exclusions for transition-related care.

“What’s most important about Starbucks’ decision is the model it sets for other employers in ensuring people can get the care they need,” she said.

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