A Franklin County employee making a gender transition might have saved for months or years before coming up with enough money to pay for a mastectomy or sex reassignment surgery. Cost estimates vary, but they can stretch well into the thousands of dollars. Now, though, those employees can hand their doctors an insurance card. It's covered.

A Franklin County employee making a gender transition might have saved for months or years before coming up with enough money to pay for a mastectomy or sex reassignment surgery.

Cost estimates vary, but they can stretch well into the thousands of dollars. Now, though, those employees can hand their doctors an insurance card. It�s covered.

On April 1, Franklin County joined a growing number of employers offering coverage for treatment of gender identity dysphoria when it changed its insurance plan with United Healthcare.

�We need to be in a position to be able to attract and retain the best and the brightest,� Commissioner Marilyn Brown said. �It would be discrimination if we didn�t do this.�

Advocates say those that aren�t offering the coverage are discriminating. A Public Library of Cincinnati employee is fighting with the organization�s board to try to obtain coverage.

About 5 percent of private companies and government entities in the U.S. offer insurance coverage that includes gender reassignment surgery, according to the Society for Human Resources Management. That�s up from 2 percent in 2011.

Fifteen state departments of insurance have said insurance plans cannot have exclusions for transition-related care.

�It�s not just a good idea. It�s the law,� said Harper Jean Tobin, director of policy for the National Center for Transgender Equality. �I think it�s in some senses a work in progress particularly in states where regulators have not spoken.�

The Ohio Department of Insurance does not offer a legal position on those exclusions because � these situations are so fact-specific,� spokesman Robert Denhard said. Federal regulators are working on their own rule.

Cincinnati�s public library hasn�t decided yet whether it will offer the coverage, spokesman Chris Rice said. Its insurer, Anthem, didn�t offer the coverage before the start of this year and the library�s board is now considering the cost to extend coverage to employees.

The employee�s lawyer, Josh Langdon, sent a letter to the Equal Employment Opportunity Commission seeking the right to sue the system.

�We�re done playing their games,� he said.

It�s up to employers to decide what coverage they offer, but cost is a factor, said Miranda Motter, CEO of the Ohio Association of Health Plans, in an email.

Much of the debate over whether the coverage should be offered is based on whether it is medically necessary. Some plans exclude coverage because it is considered cosmetic, but the American Medical Association has said it is medically necessary treatment.

Franklin County will cover continuous hormone replacement, genital reassignment, surgeries to change secondary sex characteristics such as breasts or the Adam�s apple and counseling. A policy the city of Columbus adopted in 2014 offers the same coverage.

The additional coverage will increase the county�s cost for its health plan by about 0.02 percent, though that could change based on claims, said Maggie Snow, the county�s benefits director.

County officials said they already know of several employees who plan to use the coverage.

At least one employee, who asked not to be identified, is planning to have surgery to change a secondary sex characteristic.

�This insurance being provided to county individuals is a life-saving measure,� the employee said.

Without insurance, those surgeries can be costly. Briden Schueren said his bilateral mastectomy cost about $5,100, but that was more than eight years ago. If his hysterectomy had not been covered, he said it would have cost about $22,000. He owes $220.

The cost of transitioning from a woman to a man loomed large over the decision, Schueren said. His old insurance company didn�t provide the same level of coverage he now gets through his job at Apple.

�It just makes it feel really comforting to know the company I work for and dedicate so much time to help is there for me,� he said.

rrouan@dispatch.com

@RickRouan