When Koset Surakomol decided to have a sex-change operation, the company she worked for told her co-workers that the man they'd labored alongside for a dozen years should be addressed as a woman going forward.
But EMC Corp.'s support didn't end there: The data storage company paid tens of thousands of dollars for her to undergo hormone therapy, breast augmentation and facial contouring. It also will foot the bill later this year when Surakomol has the operation that will complete her transformation -- a benefit EMC began offering in 2007.
"I got no bad reactions," says Surakomol, an information technology engineer. "All I heard was, 'This is wonderful.' "
It's a story that would've been unheard of a decade ago. EMC, with 60,000 employees, is one of a growing number of Fortune 500 companies expanding their health care benefits to meet the needs of workers who have gender dysphoria, the medical term for those who identify themselves as the opposite of the gender they were assigned at birth.
Despite the gains in coverage, many companies are unwilling to speak publicly about their benefits. But Delia Vetter, director of benefits at Hopkinton, Mass.-based EMC, says, "Everyone has a right to be naturally happy."
Nearly one fourth of Fortune 500 companies, such as Apple and General Mills, cover medical expenses associated with transgender care, according to gay and transgender rights group Human Rights Campaign. That's up from 19 percent last year. When the group began tracking transgender benefits in 2002, no Fortune 500 companies offered them.
The trend shows how much companies want their workplaces to be perceived as welcoming and progressive. Since the Human Rights Campaign began grading companies on the inclusiveness of their benefits for gay, lesbian, bisexual and transgender employees, many companies have beefed up their benefits for those groups.
Beginning in 2011, companies could only receive a 100 percent rating on the group's Corporate Equality Index by offering at least one insurance plan covering up to $75,000 worth of counseling, hormone therapy and sexual reassignment surgery -- the medical term for a sex-change operation. The number of Fortune 500 companies meeting the requirement jumped to 121 this year from 39 in 2011.
"Companies are recognizing that . . . in order to remain competitive in corporate America, you can't offer discriminatory plans," says Jennifer Levi, a professor at the Center for Gender and Sexuality Studies at Western New England University in Springfield, Mass.
While more companies offer transgender benefits, most government programs like Medicare and Medicaid classify sexual reassignment surgery as cosmetic or experimental and do not cover it.
But the federal health care overhaul could expand benefits for transgender people. The law doesn't require coverage of sexual reassignment surgery, but it's expected to lower barriers for other forms of care. Starting in 2014, insurers, hospitals and doctors that receive federal dollars won't be allowed to deny coverage to patients with pre-existing conditions, including gender dysphoria. Most U.S. insurers and hospitals receive federal payments of some type.
For most corporations the cost of adding transgender care is negligible because few people will need it. An estimated 500 to 750 Americans undergo sexual reassignment each year. According to an estimate by Jamison Green & Associates, a transgender benefits consulting firm, a company with 200,000 employees would see two people undergo sexual reassignment surgery in roughly five years.