The benefit would cover male-to-female surgery, which costs about $37,000, as well as female-to-male surgery, which runs about $77,000. It also would cover hormones and other procedures.

and

The city estimates that 17 of its 37,000 current employees are transgendered, and that as many as 35 might make use of the new benefits in the first year. Implementation of the coverage changes, which include hearing aids and acupuncture, will increase each employee's monthly insurance premium by approximately $1.70, the bulk of which will be paid by the city.

Are these numbers accurate? No! Here are the facts.

Most male-to-female transsexuals go to doctors charging between $8,000 and $13,000 US for the surgery itself. A few doctors charge more, a few charge less. The costs quoted by Planet Out are upper bounds, representing the most expensive possible surgeries, not averages.

Most female-to-male transssexuals have only the top surgery (mastectomy,) and possibly a hysterectomy, costing from $4,000 to $10,000. Only a few complete the bottom surgery (metoidoplasty or phalloplasty.) Mastectomies and hysterectomies are routine and inexpensive. Phalloplasties are rare, because the results are not very satisfactory to many transmen, and they cost up to $50,000.

Only a few transgendered people anticipate surgery. Out of San Francisco's 17 known transgendered employees, several had already completed the surgery, and many others were not contemplating it. Only three of the 17 were likely to actually use the benefit over the next several years. A rate of one surgery per year is a reasonable estimate. An estimate of 35 surgeries per year, out of a population of 3 people who want them, is a conservative estimate by the group of analysts and negotiators representing the insurance companies that contract with the City.

The numbers quoted do not take into account mental health counselling or hormone perscriptions. The counselling is required before the surgery, and could cost from $5,000 to $10,000. Hormones are required prior to and long term after surgery, and are the same prescriptions used by post-menopausal women. A cost of $300 to $1,000 per year for hormones is a reasonable estimate.

The San Francisco plan does not have additional costs for hormones and counselling because they are included in the normal mental health and prescription benefit plans by virtue of removing the exclusions for transgender and transsexual treatments; the contractual providers of health care for the City must comply with San Francisco's non-discrimination policy, which specifically includes transgendered and transsexual people.

Transgender at Work uses an estimate of $25,000 for the total medical cost for a transitioning transsexual, over a 5 year term of employment. This includes $5,000 per year for two years of counselling (one hour per week) prior to surgery, $10,000 for the surgery itself, and $1000 per year over 5 years for prescription drugs. This estimate does not include non-covered expenses, such as electrolysis, clothing, or elective cosmetic surgeries.