However, we've seen over the last few years that many states and localities have passed human rights/anti-discrimination laws aimed at inclusion for the LGBTQ community, and many insurers have broadened their policies in the past few years to include more access for transgender-related health care. For example:

• The Affordable Care Act banned sex discrimination in health care settings that have a connection to federal funds, and this law has been interpreted by the federal government to protect transgender people from discrimination;

• In 2014, Medicare removed a national exclusion on transition-related surgeries;

• In September 2015, after pressure from LGBT advocacy groups, the U.S. Department of Health and Human Services proposed a new policy, clarifying the ACA's nondiscrimination clause (Section 1557), that will enable transgender Americans to file claims of civil rights violations against physicians, insurers, and hospitals who fail to provide trans-affirmative health care.Additionally, each year the Human Rights Campaign creates a Corporate Equality Index (CEI), rating American workplaces on LGBT equality.

Since the CEI's inception in 2002, many large U.S. employers have embraced LGBT-affirming policies as a best practice. The National Business Group on Health just released their survey findings for 2016: Of the 44 respondents, 70 percent indicated their medical plan covers at least some non-surgical gender reassignment benefits (e.g., counseling or hormone replacement therapy) and 63 percent indicated their medical plan covers gender reassignment surgery.

How many insurers and/or companies now offer benefits for transgender employees?

Solid data for trans-related health care is difficult to come by. From 2002 to 2015, the percentage of major corporations with policies and benefits in place for transgender employees expanded from a mere 5 percent to almost all employers — 93 percent — according to an NBGH Issues Brief in January 2016.

Related: More hospitals, insurers embracing transgender options

However, the International Foundation of Employee Benefit Plans, which surveyed 577 human resources and benefits professionals in 2016, found that only 12 percent of organizations offer trans-inclusive health care benefits.

And, more recently, the National Business Group on Health released survey findings for Q3 2016: Of the 44 respondents, 70 percent indicated their medical plan covers at least some non-surgical gender reassignment benefits (e.g., counseling or hormone replacement therapy), 63 percent indicated their medical plan covers gender reassignment surgery, and 43 percent reported covering laser hair removal and/or electrolysis and voice surgery.

From the same survey, of the employers who do not currently cover non-surgical gender reassignment benefits, 64 percent cited the company's historical position as the reason, while 55 percent indicated that the benefit would be too expensive.

What is included in transgender health care?

Transgender health care covers a wide spectrum of benefits. Many transgender people choose not to have gender reassignment surgery or other physical alterations.

Optimally, a robust transgender health care plan would include (or should include) counseling (both in- and out-of-network, as most, if not all, therapists who specialize in transgender issues and gender dysphoria are only available out-of-network), hormone replacement therapy, non-surgical procedures (speech therapy, lab work), surgical procedures (including those that may have previously been considered aesthetic such as laser hair removal, voice surgery, facial feminization, liposuction/lipofilling, and chondrolaryngoplasty or tracheal shave), and hormone blockers for dependent children who are just entering puberty.

Transgender people are also at a greater risk for medical conditions like depression and anxiety, self-harm, substance abuse, and STDs, which should be considered when reviewing health care plan design.  

What can a trans employee do if their employer doesn't offer trans-specific health options?

The first step for a transgender employee is to contact their HR department to discuss their medical plan.

Related: Denying transgender health services could have high cost

Section 1557 of the Affordable Care Act prohibits discrimination on the basis of race, color, national original, sex, age or disability in health programs and activities that receive federal financial assistance from the federal government. The employer and/or plan may fall under the provisions of this law.

Many employers are updating their plans to include gender transition surgery and/or have received notice from their pharmacy benefit manager that certain hormone therapies and medication related to transgender health care are now included.

With emerging laws and regulations, it's important to work in partnership with the local Human Resources representative to advocate for benefits where there may be gaps, or to communicate guidance from the EEOC. If an employee does not feel they are being appropriately represented, they should contact the Office for Civil Rights (OCR) at www.hhs.gov/ocr for a complaint package, or call OCR's toll-free number at 1-800-368-1019. 

What type of response has the trans community had toward growing health care options?

According to the Human Rights Campaign, while data collection on health disparities among transgender people is limited, what data has been collected reveals a health care system that does not yet meet the needs of the community.

While support and advocacy groups are excited about the new trends towards improving health care for transgender individuals, the consensus is that much work still needs to be done. While many corporations now communicate gender transition surgery as part of their medical plan benefits, for many, this is only the tip of a very large iceberg. Here are some considerations:

• Aesthetic procedures: Surgeries and procedures currently considered "cosmetic" in nature are, in fact, vital to the overall well-being of many who wish to physically transition. Gender dysphoria, experienced by many transgender individuals, is, as defined by the National LBGT Health Education Center, clinically significant distress or impairment due to non-congruence of a person's gender role and gender identity. Therefore, for many, being recognized as the gender with which they identify is essential to living a healthy life.

• Access to health care for dependent children: As reported in the New York Times in May 2016, national numbers for transgender youth are still elusive; however, surveys show that "a higher proportion of teenagers than adults tend to identify themselves as transgender." Data for children and adolescents is even more difficult to come by — the first project to even track large numbers of children, the TransYouth Project at the University of Washington only began its work in 2013. However, as information and advocacy becomes more readily available to parents and youth, health care will need to meet an ever-growing demand for medical coverage.

While the trans community sees progress in the new health care trends, there's understandable frustration at the continued lack of access to health care for those not employed and the limited coverage available to all.

What is still needed for the trans community in this space?

I think the next step is for companies to create more inclusive workplace policies that reflect their commitment to diversity. Ninety percent of transgender individuals report experiencing harassment, mistreatment, or discrimination in the workplace, and yet 78 percent of those who transitioned from one gender to the other report they felt their job performance improved, despite high levels of mistreatment. 

Related: 5 things to keep in mind for LGBT employees and spouses

This proves that, beyond health care benefits and programs, employers should seek to provide a supportive and inclusive workplace environment, and create a culture that encourages dialogue and values diversity. These practices should be considered part of the overall health and well-being of all employees.

With regards to health care specifically, employers should consider a holistic approach not only for each transgender employee (by supporting their mental and physical well-being), but also for each employee's dependents (by supporting their transgender spouses and/or transgender children).

Transgender people face challenges in receiving health care every day. Whether it's the poor access to physicians and therapists who understand transgender issues, rejection of a claim because their insurance uses a pre-transition name or requires the gender marker to match the Social Security number, or a plan requires significant documentation in order to be eligible for a specific procedure, navigating transgender health care is taxing.

By providing knowledgeable health advocates who can assist with paperwork, mediate claims issues, and find knowledgeable providers, employers can help ease the burden of health care bureaucracy. And, by communicating a workplace's inclusivity, including and especially the employer's commitment to spending health care dollars on transgender benefits, an employer can expand their attraction and retention messaging.

If the current data is correct, which reflects 0.3 percent of U.S. adults are transgender, then the cost to provide trans-related health care is minimal, while the employee value proposition that evokes acceptance and diversity would be paramount to creating a culture of equality and respect.

What will Trump's presidency mean for transgender health care and is this a concern?

While it is still unclear what direction the Trump presidency will take, his administration is expected to usher in many disheartening changes for the transgender community.

In addition to Vice President-elect Mike Pence and the appointment of Steve Bannon as chief strategist, it's clear that Trump is assembling an anti-LGBT team.

Trump has promised to repeal the ACA — which would mean many in the transgender community would go without health insurance and those with health insurance could be denied trans-affirmative care.

While it is unlikely that Trump would repeal, or be able to repeal, the ACA in its entirety, there is great concern that any changes Trump would enforce would make access to trans-affirmative care much more difficult. Some employers are even reaching out to employees to voice support and solidarity.

Ultimately, health care coverage for transgender employees may rest solely with employers; however, those who do not have health insurance or supportive employers will lose all that has been gained over the last few years. The ramifications of this will be felt for years to come.