When most of the city's approximately 10,000 employees seek mental health care, hormone treatments, or a variety of other services, they don't need to prove medical necessity to receive coverage under the city's employee benefits plan. But once the city's insurance carriers have classified an employee as transgender, those services may be "universally denied," says the Seattle LGBT Commission in a letter to city officials.

The commission, which advises the mayor and city council, says these exclusions should be removed when the city writes the new employee contracts by 2013. Commissioners were set to meet with city officials on May 10, as The Stranger went to press.

Mayor Mike McGinn says he agrees with the commission's recommendations.

"This is something we should be working to improve," says McGinn, who only learned about the exclusions this month. "This is not a frivolous issue. It's a fundamental issue about the effect on a person's physical and emotional well-being, and this exclusion means that you are denying appropriate health services to people when they are in need."

In March, the commission wrote to the city council and personnel department: "First and foremost, transgender medical treatment is not cosmetic. It is necessary medical treatment. Psychological care, hormonal treatments, and surgical procedures are all medically necessary for transgender-­identified individuals."

This discrimination is, in fact, quite explicit for the city's trans employees: The benefit plan for city workers says insurance won't cover "any treatment, drug, service, or supply related to changing sex or sexual characteristics." That includes gender reassignment surgeries, hormone therapy, or counseling.

Of the city's employees and retirees covered under its medical plans, 8,188 are covered by Aetna and another 2,765 by Group Health, says Julie Curtis, a compliance manager in the city's personnel department.

In response to the letter, which was first reported by Seattle Gay News, Seattle City Council member Sally Clark tells The Stranger she didn't know about the exclusions either, until the letter. Clark says, "I'll be looking at how we can change what we should cover."

Although extended coverage comes at a higher cost, employees probably won't rush to obtain expensive procedures. For example, San Francisco began covering trans employees in 2001. The commission writes, "During the period 2001–2006, the City of San Francisco increased premiums for transgender coverage totaling $5.6 million, but only paid out $386,417 in claims."

"This is a pretty modest issue compared to the significant issue we have of health care costs of the city as a whole," says McGinn. But he adds: "This is a fairness issue; it's not about costs." recommended