Health benefits that matter to the LGBTQ+ community: By the numbers 

Our research over the past few years has tracked the ways employers are working to align employee benefit programs with their organizations’ overarching DEI goals. For Pride month, here’s a round-up of survey results relating to health and well-being benefits of particular importance to the LGBTQ+ community.

Although our long-running National Survey of Employer-sponsored Health Plans recorded steady growth in same-sex domestic partner (DP) health coverage in the years leading up to the US Supreme Court decision in Obergefell v. Hodges, it declined over the next five years, presumably because some employers assumed that DP coverage was no longer necessary once same-sex marriages were legal. However, this assumption overlooks barriers to marriage that many LGBTQ+ couples still face; entering into a legal same-sex marriage can still expose individuals to prejudice and discriminatory actions. In addition, non-traditional family structures generally have become more common, and domestic partner coverage is an increasingly popular benefit among all employees. It’s not surprising, then, that in recent years the trend away from same-sex DP coverage has reversed. In 2022, 56% of large employers (500 or more employees) offered DP coverage to same-sex couples – still down from the 2015 peak of 62%, but clearly on the rise. The Human Rights Campaign Corporate Equality Index emphasizes the importance of offering DP benefits that are equal to that of spousal benefits, regardless of sex or gender.

Employers with 500 or more employees    

In our recent survey on Health and Benefit Strategies for 2024, about two-fifths of large employers (41%) indicated that they have taken steps to provide equitable family-building benefits to support all kinds of families. Over the past few years, we have seen significant growth in coverage for IVF (prevalence among large organizations reached 43% in 2022) and the majority of employers that offer it have chosen not to limit coverage to those meeting the clinical definition of infertile – which means that the benefit can be used to support different kinds of families. In addition, 15% of large employers cover elective egg freezing, which helps individuals preserve future fertility and can be of value to those undergoing gender affirmation treatment that could render them infertile. Finally, financial support to help cover the cost of surrogacy is provided by 14% of all large employers and by 23% of those with 5,000 or more employees.

These family-building benefits may not be used by many employees, but they can be very important to those who need them. For LGBTQ+ employees seeking to start a family, they may be a key differentiator in employment decisions and satisfaction.

Many employers now cover gender affirming care to some degree. Half of all large employers covered gender affirmation surgery in 2022, as did nearly three-fourths of those with 20,000 or more employees. Of the employers covering surgery, nearly all (93 percent) also cover some associated services, primarily behavioral health services/counseling (89 percent) and non-surgical gender affirmation treatment/hormone therapy (79 percent), and other associated services such as reconstructive procedures (60 percent).

A separate Mercer survey on new and emerging leave policies found that 8 out of 80 US organizations responding (10%) provide employees with gender affirmation leave, most often with at least some time paid. An additional 4% were considering it. Typically a mix of paid and unpaid time off, gender affirmation leave allows eligible employees to take time off to tell their families and friends about the change, undergo gender affirmation surgery and follow-up care (which may involve travel if not available in the employee’s home state), adopt a style of presentation that aligns with their identity, and take the necessary steps to legally change their name and pronouns.

Mercer’s Inside Employees’ Minds survey asked more than 4,000 US employees to rank a list of 16 possible concerns that might be keeping them up at night or preventing them from focusing at work. Overall, mental health was ranked fifth. Among LGBTQ+ employees, however, it ranked second, behind financial concerns. LGBTQ+ employees also reported significantly higher levels of exhaustion and frustration during a typical day than non-LGBTQ+ individuals. Not surprisingly, LGBTQ+ employees place higher-than-average value on mental health benefits.  

While the majority of employers have been investing in improving access to behavioral health care, some have taken the extra step of providing specialized mental health support for LGBTQ+ members: 17% of large employers provide enhanced resources and another 22% are considering it.

As discussed in detail in this blog post, designing policies to better serve LGBTQ+ employees is complicated. There is a lack of data, privacy and safety concerns, and a wide spectrum of needs – after all, this community is not a monolith. Employers have begun asking employees to share information about their sexual orientation and gender identity so they can uncover issues and advance DEI goals. But as we’ve seen, there is much that can be done now with the basic benefit offerings described above to help meet the needs of LBGTQ+ employees in a more equitable way.