The answer to this question depends on what the employer's contract with the health insurance company says. Currently over 200 of the largest U.S. employers offer health insurance plans that cover transition related medical treatment. New developments have addressed gender identity discrimination at the state and federal level. At the federal level, the automatic ban on Medicare coverage for sex reassignment surgery has been lifted. The U.S. Department of Health and Human Services has stated that sex reassignment surgery is a medically necessary and effective treatment for people who do not identify with their biological sex, and thus Medicare will not automatically deny coverage. Coverage will be determined on a case-by-case basis. While some companies that provide medical benefits for employees undergoing sex reassignment choose not to publicize the benefit, most simply do not offer the benefit, citing cost concerns, previous lack of demand, and/or the policies of the company's insurance carrier. However, if you work for a company which has a policy prohibiting discrimination on the basis of gender identity and/or gender expression, or company management has proven to be receptive to transgender workplace issues, it may be possible to convince your company to take the next logical step to fully support the medical needs of transgender employees. If your employer is interested in assisting transgender employees by covering sex reassignment surgery under existing insurance coverage, it may be necessary to explore whether the company's insurer will allow this benefit to be offered, or to change insurance companies. It also may be helpful to consult with other companies offering sex reassignment surgical coverage to obtain more information about the potential costs and coverage needed. States are rapidly beginning to change their laws in this area. The costs associated with transitioning are not just those related to the actual surgery. Psychological counseling is required in order to undergo sex reassignment surgery. Hormone treatments are one of the biggest expenses, but follow-up doctor's office visits and medical care are also necessary. While your employer may incorrectly assume that the costs associated with sex reassignment are cosmetic or elective, medical professionals have recognized gender dysphoria is a mental/psychological diagnosis. If someone is diagnosed as gender dysphoric, sex reassignment surgery is often recommended as a component of that treatment. However, many insurance policies exclude sex reassignment surgery and other treatments for gender dysphoria from the list of covered medical procedures.