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Resolution 19-03 Concerning State Health Plan Coverage





April 3, 2019


WHEREAS the Mission of the Employee Forum is to address constructively the concerns of the Employees of The University of North Carolina at Chapel Hill, including the representation of staff concerns to the Chancellor, University officials, and the University community; and


WHEREAS, these concerns include UNC’s commitment to hire and retain the top candidates for its faculty and staff[1] and its commitment to all employees to provide quality healthcare at an affordable cost; and


WHEREAS, UNC is committed to providing an inclusive and welcome environment for all members of our community, valuing safety, diversity, education, and equity; and is firmly committed to maintaining a campus environment free from discrimination[2]; and


WHEREAS, the University Policy Statement on Non-Discrimination[3] mandates that the University does not unlawfully discriminate in offering equal access to its activities with respect to employment terms and conditions on the basis of an individual’s age, color, disability, gender, gender expression, gender identity, genetic information, race, national origin, religion, sex, sexual orientation, or veteran status, collectively referred to as “Protected Status;” and


WHEREAS, this policy and protection of these statuses is grounded in state and federal law[4] with recent federal case law in Boyden v. Conlin,[5] holding that the State violated the ban on sex discrimination in the Civil Rights Act and the Affordable Care Act (ACA) as well as the Equal Protection Clause of the 14th Amendment[6], and must cover transition medical costs for transgender state employees; and


WHEREAS The Human Rights Campaign (HRC) 2018 State Equality Index[7] scored North Carolina as “High Priority to Achieve Basic Equality,” the lowest possible scoring group in the annual ranking and analysis performed by the HRC with transgender health care coverage cited as one of the areas in which North Carolina is especially lagging in achieving basic equality; and


WHEREAS, in 2017 following the passage of the Affordable Care Act, the employee health plan provided coverage of medical procedures including hormone therapy, psychological counseling, and surgery related to transition for transgender employees, but coverage for those services was summarily excluded in the 2018 and 2019 benefit years and currently remains excluded[8]; and


WHEREAS, the insurance exclusions for transgender healthcare are for services currently being covered for cisgender employees in similarly situated circumstances (including psychological assessment, psychotherapy, hormone replacement therapy, and medically necessary surgical procedures) and


WHEREAS, the care coverage being excluded is for medically necessary services to treat gender dysphoria as defined by the American Medical Association, American Psychiatric Association, American Psychological Association, and World Professional Association for Transgender Health; and

WHEREAS, the cost to make an insurance plan inclusive of such medically necessary care for all eligible employees is not fiscally prohibitive[9] and would not substantially increase either the employer-paid portion or employee-paid portion of health care coverage[10]; and


WHEREAS, these exclusions are discriminatory based on unlawful distinctions, preference and detrimental treatment coverage determinations to individuals in a Protected Status which interferes with their work environment, participation in University benefit programs, and receipt of medically necessary services which would otherwise be covered by the State Health Plan if they were not requested in conjunction with gender transformation; and


WHEREAS, seven out of UNC’s fifteen peer institutions offer inclusive health insurance coverage for treatment of gender dysphoria[11] and 58% of Fortune 500 companies provided coverage for transition-related care for transgender employees;


BE IT RESOLVED, that the Employee Forum of the University of North Carolina at Chapel Hill is resolutely in support of inclusion of all employees for eligibility, participation, and coverage of the full benefits afforded by the State Health Plan.  In particular, the Forum supports transgender employees’ access to the same medical coverage afforded to cisgender employees in the current benefit plans, including coverage for hormone replacement therapy, psychological assessment and counseling, and surgical procedures deemed medically necessary by a healthcare provider.


THEREFORE, the Employee Forum recommends that the Chancellor and their designees convey and support publicly the concepts of this resolution in dealing with the North Carolina State legislature and Board of Governors; and


FURTHERMORE, the UNC-Chapel Hill Employee Forum asks the State of North Carolina and the General Assembly:

1) Remove the exclusions from coverage for medical care related to transgender transition care from its State Health Plan;
2) Provide coverage to all employees for medically necessary treatments, including hormone replacement, psychological counseling and assessment, and surgical procedures;
3) Maintain commitment to keeping state employee healthcare accessible and affordable for all eligible employees.


Signed on behalf of the Employee Forum,




Shayna Hill,


[1] Blueprint for Next

[2] UNC-CH Policy on Prohibited Discrimination, Harassment, and Related Misconduct, page 2.


[4] Including North Carolina General Statutes § 143-422.2, Title VII Of the Civil Rights Act of 1964, prohibiting discrimination in employment based on Protected Status, and Title IX of the Education Amendments of 1972, prohibiting discrimination based on sex, also applies to employment and education programs and activities. Executive Order 13672 revised Executive Order 11246 (applicable to federal contractors, including the University) to prohibit discrimination based race, color, national origin, religion, sex, sexual orientation, and gender identity.

[5] Boyden v. Conlin, 2018 WL 4473347, 2018 U.S. Dist. LEXIS 158491 (W.D. Wis.)

[6] “The Constitution of the United States,” Amendment 14.


[8] 80/20 PPO benefits booklet, Mental Health and Substance Abuse Services Exclusions and Limitations: page 42, “Psychological assessment and psychotherapy treatment in conjunction with proposed gender transformation”; Page 52, stating that The Plan does not cover services, supplies, medications or charges for: “Treatment or studies leading to or in connection with sex changes or modifications and related care.”

[9] U.S. policymakers generally deem medical services to be cost-effective if the price falls below

$100,000 per year of quality of life. The Hopkins research team found that in the first five years of care for transgender people, associated medical care costs between $34,000 and $43,000 per year of quality of life. After 10 years, the costs drop to $7,000 to $10,000 per year.

Johns Hopkins University December 3, 2015

[10] Massachusetts Group Insurance Commission calculated the budget impact of providing transgender inclusive coverage was $.016 per member per month (Source: Societal Implications of Health Insurance Coverage for Medically Necessary Services in the US Transgender Population: A Cost-Effectiveness Analysis. (2016). William V. Padula, PhD MS MSc1, Shiona Heru, JD2, and Jonathan D. Campbell, PhD3. Journal of General Internal Medicine 31(4):394-4-1.)

[11] University of California – Berkeley, University of California – Los Angeles, University of Southern California, University of Michigan – Ann Arbor, University of Maryland – College Park, Johns Hopkins University, Duke University, University of Minnesota – Twin Cities, University of Pittsburgh, University of Texas – Austin, University of Virginia, University of Washington – Seattle, University of Wisconsin – Madison, Northwestern University, University of Pennsylvania

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