DOI: 10.3886/e120901v4
title: Health Insurance Contract Analysis (2019: Corporate, CA, MI)

description: <br>These data include PDF files of 1496 health insurance contracts from the year 2019 in the United States. They come from 40 corporations [435 self-insured plans using third party administrators (TPAs)] and health insurance contracts from the individual, small group, and large group markets sold in the states of CA (852 plans) and MI (209 plans). The Excel spreadsheet is our coding sheet for all of these contracts analyzing transgender health care coverage options. <br><br>We drew these contracts from AXIACI from Leverage Global Consulting, a proprietary database that contains insurance plan offerings and coverage from private and public insurance market segments. Our use of the proprietary database for the purposes of public policy research and analysis in health insurance is governed by a data use agreement between Leverage and Professor Anna Kirkland.<br><br>We use the term “contract” to mean the Summary Plan Documents (SPD), which is the roughly 100-200 page document that an individual gets from their health insurance company describing coverage and exclusions. These are the documents contained here. Other documents include the Member Handbook, Certificate of Coverage, Summary of Benefits and Coverage, Subscribers Contract, medical policies, and drug formulary, all of which are distinct and differently regulated documents. <br><br><br>
description: The universe of all health insurance contracts offered in the United States at any given time is not known (by anyone). It is not known because there is no census of insurance contracts and no central place where they are required to be registered or noted. This database contains insurance plans available to us by agreement with a healthcare consulting firm, Leverage Global Consulting, as of July 2019. .
description: We accessed AXIACI from Leverage Global Consulting, a proprietary database that contains insurance plan offerings and coverage from private and public insurance market segments. Our use of the proprietary database for the purposes of public policy research and analysis in health insurance is governed by an agreement with Leverage.<br><br>The contracts from Michigan and California plus a sample of corporations are included as PDFs. We use the term “contract” to mean the Summary Plan Documents (SPD), which is the roughly 100-200 page document that an individual gets from their health insurance company describing coverage and exclusions. These are the documents that our team analyzed. Other documents include the Member Handbook, Certificate of Coverage, Summary of Benefits and Coverage, Subscribers Contract, medical policies, and drug formulary, all of which are distinct and differently regulated documents (not in this deposit).<br><br>We operationalized details of the current WPATH-recommended transgender health benefits into 52 discrete elements in a spreadsheet. Following a detailed written search procedure, the authors and a team of research assistants analyzed each contract for these elements. Each research assistant received training on searching the contracts, and the research team met weekly to discuss questions and to resolve ambiguities. The first author checked the spreadsheet responses for accuracy by searching a sample within each corporation. Samples to check were drawn from different carriers under the same corporation, because carrier documents tend to be similar. If any errors were found, the entire section of all contracts for that corporation would be re-done and checked again by two different coders.We coded both for the overall type of exclusion language linked to gender-affirming care as well as whether particular WPATH-recommended care was mentioned as excluded or not. At the first level of coding, we noted whether there was any exclusion language relevant to gender-affirming care at all (and of course there would not be if there was no gender-affirming care mentioned), and then whether the exclusion was generic language about cosmetic, experimental, or investigational exclusions (but referring to trans care specifically) or whether there were additional trans-specific exclusions listed.<br><br>We also include an Excel downloaded file from our Google spreadsheet used in our analysis, showing our coding results for all these elements for each of the included contracts.<br><br><br>