2023 Global Medical Trends Survey
Benefit policy exclusions persist for services that support DEI strategies, a key priority for many organizations. Many insurers’ policies have exclusions related to gender, a diversity lens that is most consistently a focus of organizations. Globally, approximately three-quarters of all group policies exclude fertility treatments. This figure is even higher in some regions. Roughly 85% of all group policies in Asia Pacific exclude these treatments as do over 90% of group policies in the Middle East and Africa.
Exclusions for gender transition surgery follow a similar pattern. Globally about 75% of all group policies exclude this type of surgery. This figure rises to over 85% of all group policies in Asia Pacific and 93% of all group policies in the Middle East and Africa.
Additionally, exclusions for doulas and midwives are found in approximately three out of five group policies globally. At the same time, exclusions for treatments related to menopause exist in about 37% of all group policies on a global basis.
Exclusions for HIV/AIDS persist despite the existence of treatments to make this a manageable chronic condition. The percentage of group policies covering more than 500 employees globally that exclude treatments for HIV/AIDS has steadily increased from 41% in 2020 to 54% in 2021 to 57% in 2022.
Moreover, at the most foundational level of inclusive benefits, insurers continue to report exclusions for same-sex legal spouse or domestic partners. Approximately a quarter of all group policies globally regardless of size contain these exclusions. Sixty percent of insurers attribute these exclusions to legal restrictions.
Insurers are facing pressure to modernize and redefine their benefit packages in response to the growing demand from organizations that are aligning benefits with their DEI strategy. The challenge can be complex, particularly for multinationals that strive for global benefit consistency or consistent minimum standards. In some countries, exclusions are a result of legal restrictions; in others, exclusions may exist due to government-provided social benefits, and in still other countries, insurers may not have enough experience to price the benefit effectively. Moreover, economic uncertainty fueled by rampant inflation and a looming potential recession is another factor impacting both insurers and organizations exploring the possibility of removing exclusions.
As organizations further align their benefits with their DEI strategies and insurers modernize their offerings, there may be opportunities to remove exclusions to drive greater benefit inclusivity, better meeting the diversity of employee health needs. Some may be at a low or nominal cost where the insurer feels they can better understand and price the risk and the utilization is low (e.g., domestic partner coverage, doulas/midwives, menopause coverage), while others may be areas of pricing development that will only be further refined as more organizations remove exclusions (e.g., fertility treatments, gender reaffirming surgery [i.e., sex change]).
It is important to discuss the intent of globally consistent benefits or minimum standards and the benefits to be included, factoring in social benefits provided by the government. Also critical is a discussion of the governance structure used to make equitable decisions. Working with their consultants and brokers, organizations can make important strides to bridge these coverage gaps and help deliver more equitable health outcomes across different employee groups while also managing costs.
