Canada ramps up transgender assessments: but what about health insurance?

by Paul Lucas11 Mar 2016
Ontario is attempting to address a significant backlog in the number of people waiting for sex reassignment surgery by increasing the number of healthcare professionals that can assess patients.

With a waiting list currently stretching to more than 1,500 people – meaning around a two-year wait for a referral – efforts have been made to make the process simpler. Previously, patients could only get referrals from the Gender Identity Clinic in Toronto, but now there will be a wide range of practitioners who are able to offer assessments.

So what about health insurance for those seeking gender reassignments? Life and Health Professional spoke to Joan Weir, director of health and dental policy at the Canadian Life and Health Insurance Association (CLHIA) to examine the issue.

Of course when it comes to transgender surgeries, the Canada Health Act requires that medical services be funded publically, so each province is responsible for determining which surgeries they will pay for under the provincial health program. Insurance carriers are not able to fund these services. However, what about the costs of treatments which are needed post-surgery?
“Individuals and families have access to group insurance coverage through employment or can purchase individual insurance at any point,” said Weir. “Typical coverage includes prescription drugs.  

“Transgender individuals will typically have access to coverage for hormonal therapy pre- and post-surgery, as well as any other medications they may need in their transition or post-surgery. The insurer will not know the reason why someone may be taking hormonal therapy or any other prescription drugs. In addition to prescription drugs, an individual may require, as examples, massage therapy or physiotherapy post-surgery. Health insurance will typically include coverage for massage therapy and physiotherapy. Again, the insurer will not need to know the reason for the service.”

So what complications, if any, can a transgender person expect to encounter when seeking health insurance? According to Weir, individuals applying for new individual insurance will need to disclose current medications that they are taking and sometimes those medications may be excluded from coverage through the new insurance - this could apply equally to someone on blood pressure medication as it could to someone on hormone therapy.  

“For someone already with a group or individual health plan or who becomes employed and has new group insurance, who starts to transition, there would not be any barriers to accessing the prescription medications and health services needed,” she said. “The only ‘complication’ that can present itself is that, as an individual transitions over time, they may decide to officially change their name/gender. As name and gender are parts of their insurance record against which claims are validated, they’ll need to remember to update their record at their insurer, in order to avoid claim rejections.”

According to reports, Rainbow Health Ontario has already taken more than 800 health professionals through the training necessary for making assessments about gender operations – this includes how to help someone prepare for the procedure, information about surgical and hormone options and the necessary support a patient will need after an operation. Currently however, there are no surgical options in Ontario although Health Minister Eric Hoskins has promised some funding towards a program meant to support chest surgeries at Women’s College Hospital.