Delivering American University's news and views since 1925. | Sunday, January 20, 2019

AU insurance lacks transgender coverage

In part two of this series, The Eagle examines transgender exclusion in AU's student health care plan, and the ways students are fighting to get those benefits covered.

Atop Diversity Advocacy Director Jillian Rubino's desk rests a document that means the world to her and to countless other AU students.

The university's "Discrimination and Discriminatory Harassment Policy," first introduced in 1999, highlights AU's stance on diversity and identity. According to the document, the university prohibits discrimination based on "gender identity and expression," among other things, in "every aspect of the operations and activities of the university, including admissions and employment."

That is, to every operation and activity except university health care, Rubino said.

Buried at the bottom of AU's 2008-2009 student health care brochure is its policy "exceptions" - a series of statuses, ailments, preconditions and treatments that GM Southwest, AU's new insurance carrier, does not cover. Although these exclusions are commonplace in any insurance policy, most painful to Rubino is No. 30: "Expenses incurred for, or related to, sex change surgery or to any treatment of gender identity disorder."

"Most students have no idea," Rubino said, acknowledging that there might be more dissatisfaction over the issue if more AU students subscribed to the university's health care plan. "I'm outraged, and my major problem is that we have a non-discrimination policy to protect against this kind of thing."

The transgender health exclusion is not new to this year's student health care plan, Rubino said. Chickering did not provide transgender-specific student care either, according to the 2006-2007 and 2007-2008 policy brochures, which were recently removed from the Student Health Center's Web site.

"The [benefits package] we have now ... has been around since before I got here in 2004," said Dan Bruey, director of the Student Health Center. "But it's not that AU wanted to exclude this population ... it's more that if we did it, we wanted to do it right and make sure it's the best thing for all enrollees on the plan."

De facto discrimination

Part of the difficulty with covering transgender care at the student level is defining and pricing its benefits. Health insurance providers - not to mention, plan enrollees - often disagree over whether to cover sex reassignment surgery (SRS), gender identity counseling, hormone therapy or some combination of the three, according to Nick Sakurai, former program coordinator of AU's Gay, Lesbian, Bisexual, Transgender & Ally Resource Center.

Despite the disagreement, a few templates at the college level do exist, Sakurai said. A handful of U.S. schools, many of which are part of the University of California network, have implemented transgender-friendly health plans at reasonable prices. According to the UC Lesbian, Gay, Bisexual, Transgender and Intersex Association, UC-Santa Barbara, for example, covers SRS and hormonal treatments, provided transgender students seeking care first pay a $300 deductable. Other schools, including the University of Michigan, fully cover some "gender reassignment service expenses" up to $5,000; at $5,001 and above, students must pay for a fraction of their treatments, according to the school. UM, according to its Web site, uses Chickering as its student carrier - the same provider AU used prior to 2008.

AU has not negotiated any such benefits, Sakurai said. Part of the reason is that the push for transgender inclusion has been limited to the faculty and staff level. The proposal Sakurai's office issued to the university in October 2006 has yet to produce tangible results, and transgender health benefits are still not included in staff insurance. That lack of progress, combined with students' general uncertainties about health care administration, has kept the movement from gaining traction among the student body, Sakurai said.

"I wanted students to bring it to the table," he said, adding that his office did try to generate interest in the cause last year. "If the plan comes down to a compromise, students should make the decision about which benefits to include."

Even so, the tone of those limited conversations has tended to emphasize the wrong elements, Sakurai said.

"Unfortunately, the transgender health discussion is usually associated with economics," he said. "But it costs less [to student enrollees] to provide transgender care than it does to exclude it. We'll cover the ailments of not being included, like depression, but not transgender care. Meanwhile, excluding it sends the message that transgender care doesn't matter."

According to Bruey, the university has started to work with GM Southwest to figure out the logistics of transgender coverage. However, it remains unclear when those benefits will be in place, he said.

"If we're the school we say we are, and we're all-inclusive, then we want to cover all areas, and we want to do it right," he said.

Communicating more frequently and efficiently

Lapses in communication are partly to blame for the HPV and trans-health oversights, said Student Government President Seth Cutter. Simply put, the health insurance conversation was lost in the shuffle between SG administrations, which were too busy with the transitioning process to keep it on their radar, he explained.

"I was unaware we were changing carriers; it was not until May, when everyone else found out, that I knew of the switch," he said. "That's when we started talking to [Bruey]."

This, unfortunately, meant that Women's Initiative and other groups that intended to petition the office to include HPV and transgender coverage never made it to this year's discussion table, according to Women Initiative Director Ashley Evans.

Bruey said he did meet with law students, who, along with other graduate students, represented 1,968 non-undergraduate students enrolled in the plan last year.

"Could communication and participation have been better? Absolutely," he said. "But most undergraduates waive [AU's policy]; they have their own insurance."

The university, however, hopes to remedy its errors, starting this fall semester. With the help of the SG, the health center plans to launch a Student Health Advisory Board designed to serve as a liaison between students on the plan and university decision-makers, Cutter said.

The new committee consists of six standing members - including the Student Government, Women's Initiative and the Undergraduate Senate - as well as four student representatives, all of whom must apply for the position, Cutter said.

As of early August, Rubino, in either her role as the director of Queers and Allies or director of Diversity Outreach, had not been approached about a spot on the board, she said.

The committee will also play a role in improving health center communications, starting with reconfiguring its Web site and making insurance benefit information more available to enrollees, Evans said.

However, there are no pre-requisites to serve on the panel, and students do not need to have prior knowledge of health insurance to apply, Cutter said.

You can reach this staff writer at

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