One in about 10,000 to 20,000 employees typically uses gender transition coverage per year, according to a study by Jody Herman, who researches law and public policy related to gender identity at the University of California at Los Angeles. Since the University of California schools added related benefits in 2005, fewer than a dozen people a year out of more than 100,000 have used the benefits, according to a California Department of Insurance report. The average claims cost was $29,929.
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Aetna says it doesn't charge corporate clients extra administrative fees for adding transgender coverage. The Hartford, Connecticut-based insurer's transgender benefits packages typically include genital surgery and breast removal, although not surgeries Aetna considers cosmetic, said Bob McDonough, senior director for clinical policy research and development.
Doctors, too, are seeing a rush. Curtis Crane's practice in San Francisco will do about 700 surgeries this year related to gender change, he said. He's adding another doctor for an expected 1,000 surgeries next year and opening a second office in Austin, Texas. "Now instead of a six-month wait list, I have about a year wait list," he said.
When Crane started his transgender practice three years ago, about 90 percent of patients paid in cash, he said. Now it's about 95 percent paid by insurance. A full transition from a woman to a man, the most complex surgery, can cost more than $150,000, he said.
HRC, the advocacy group, gathers data from hundreds of companies every year related to benefits for LGBT employees. A perfect score in the so-called corporate equality index is 100 points, a bar that changes periodically as the group adds more criteria. To be counted as offering transgender coverage this year, a company has to offer at least $75,000 worth of related benefits and meet other standards of care including providing counseling.
The U.S. government has proposed new rules that would bar most insurance companies from categorically denying coverage for treatments that can help people transition to another gender. The rules wouldn't force insurers to pay for all procedures, although they'd probably mean wider coverage of some treatments, such as hormone therapy.
Whatever the regulations, peer pressure will probably drive more large companies to sign on, said David Mayer, a University of Michigan business professor who studies workplace diversity. "Other companies feel they should and need to offer similar benefits," he said. Wal-Mart, the world's biggest retailer, may be one. The company reviews its insurance coverage each year, said spokesman Randy Hargrove, noting that new gender-identity policies and same-sex partner benefits have helped Wal-Mart's score rise to 90 from 30 in the past two years on HRC's index. "Our decisions are based on what we believe are best, and that will enable us to remain competitive and continue attracting and retaining great talent," he said.
If insurance companies pick up the bill, it segues into salvaging more relationships.
Erica Lachowitz, 39, said she had to borrow some of the $50,000 she has spent on facial surgeries to transition from a man to a woman, which she figures will ultimately cost about $100,000. Her employer, a door-manufacturing company, provides health insurance but not transition procedures.
"If insurance companies pick up the bill, it segues into salvaging more relationships" at home, she said. "It removes a huge burden of stress for the person who looks at this and says, 'I can do this.'"
During normal driving, the cars with the software -- known as a "defeat device" -- would pollute 10 times to 40 times the legal limits, the EPA estimated. The discrepancy emerged after the International Council on Clean Transportation commissioned real-world emissions tests of diesel vehicles including a Jetta and Passat, then compared them to lab results.
VW said it's cooperating with regulators probing gaps between emissions on the road and lab tests on some diesel models. According to the EPA, the company insisted for a year that discrepancies were mere technical glitches.
Winterkorn, who has led VW since 2007, was forced to halt sales of the cars on Sunday and issue a public apology, saying he's "deeply sorry" for breaking the public's trust and that VW would do "everything necessary in order to reverse the damage this has caused."
The violations could result in as much as $18 billion in fines, based on the cost per violation and the number of cars.
The U.S. accusations are "grave" and must be clarified swiftly, said Stephan Weil, prime minister of the German state of Lower Saxony, which owns 20 percent of Volkswagen's voting shares. "Possible consequences can be decided after that."
The European Commission also said it's taking VW's cheating seriously and is in contact with U.S. regulators and the company about details of the case.
