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Why Gender-Affirming Care Belongs in Every Health Plan
17 Plays1 month ago
What does it really mean for a workplace to offer gender-affirming healthcare?
Many organizations believe their extended health benefits already cover trans and non-binary employees, but the details often tell a different story.
In this episode, we explore how gender-affirming care is often treated as an optional add-on rather than a core part of health coverage - and why that matters. From laser hair removal and hormone therapies to vocal training and mental health support, these benefits are far from “cosmetic.” They’re essential for wellbeing, safety and equity.
We also unpack the barriers that still exist, like the requirement for a gender dysphoria diagnosis, and how organizations can push back to create genuinely inclusive benefit plans. Whether you’re an HR leader, a small business owner or someone advocating for change from within, this conversation offers clear, practical insights into what inclusive healthcare really looks like, and why it benefits everyone.
Download our extended healthcare plan here: https://drive.google.com/file/d/1L4v0WnWrh2klY1wf44NG-scU_5fptDEc/view
Key themes: gender-affirming care, healthcare equity, trans inclusion, extended health benefits, workplace wellbeing and inclusive policy.
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Transcript
Introduction to Gender in Focus Podcast
00:00:04
Speaker
Welcome to the Gender in Focus podcast. I'm Elle and each week I get to ask Kai Scott, the president of TransFocus Consulting, all the questions you have ever wanted to ask about trans and non-binary people in the workplace and in the wider world.
Importance of Gender-Affirming Care Benefits
00:00:18
Speaker
but When we talk to trans and non-binary employees, if there's gender affirming care benefits, this is a big topic of discussion. Some people will actually move jobs to go to a company that provides this type of care, especially if they really need it.
00:00:35
Speaker
And so it's a deciding factor in whether people will join a company or not.
00:00:42
Speaker
You just not trusted that you're an adult who can make decisions for yourself. If I think about, for example, cisgender woman who want to get hysterectomy and they haven't had children, there's this like jumping through hoops to to prove that you know yourself or that you can make decisions for yourself. Like you don't need to be diagnosed with anything. You can just say, this doesn't work for me. And I would like this, please.
00:00:59
Speaker
Like that's enough. Or should be enough.
00:01:05
Speaker
Most workplace health plans think they cover trans and non-binary employees. But what does that really mean? For trans employees, the details matter.
Challenges in Health Plan Coverage for Trans and Non-binary Employees
00:01:14
Speaker
Many plans treat gender-affirming care as an optional add-on, often at little to no extra cost, yet still hide big barriers like requiring diagnosis or completely missing important procedures.
00:01:27
Speaker
In this episode, we'll unpack where current benefit plans fall short, why these gaps matter, and how truly inclusive coverage is less about cost and more about care.
00:01:39
Speaker
And I'm joined by my esteemed colleague, Elle. How are you doing? I'm doing great. How are you doing, Kai? Fantastic. I'm glad to hear that. I'm doing well also.
00:01:50
Speaker
And I'm excited to get into this topic because for some, especially if they're in human resources, it's on their radar.
Understanding Gender-Affirming Care
00:01:58
Speaker
For others, they sometimes are surprised by this kind of lesser known benefit that is definitely important for trans and non-binary folks.
00:02:08
Speaker
hey Yeah, lesser known is definitely like the key. I think it's, I've had some really interesting conversations with other people about this, because they didn't think they even realized that this was a thing that that can exist.
00:02:20
Speaker
And so I guess that's kind of where I wanted to start, which is, what do we mean by gender affirming healthcare benefits? Yeah, the million dollar question actually it doesn't cost that much.
00:02:32
Speaker
Here, we'll provide it for free. HR stressing. Yeah, yeah. Oh, really? A million? What? ah So yeah, gender affirming care benefits is this category of benefits that can be added to an existing extended healthcare but benefits package.
00:02:50
Speaker
at least here in Canada. i In the United States, it might be a fairly different landscape, especially in current political environment. ah However, here in Canada, certainly it's it's a much easier affair.
00:03:02
Speaker
And basically it's everything that um is useful and helpful to trans and non-binary folks. Of course, when it comes to gender affirming care, there's so many different options available ah to trans and non-binary folks.
00:03:17
Speaker
You know, whether it's top or lower surgeries, laser hair removal, hormone treatments, ah you name it there's so many different ways that people can access care. Now, of course, not everybody is accessing this type of care, but certainly for those who need and want it, it is important to access Here in Canada, there's a key difference in that some, especially the major procedures, are covered by a provincial or territorial health care plans. So thankfully, it's a publicly supported um endeavor, but unfortunately, it doesn't cover everything. And that's where the gaps can be closed by extended health care benefits ah for support in gender affirming care.
Equity in Healthcare Access
00:04:00
Speaker
One little asterisk that I'll add to it is gender affirming care isn't just for trans and non-binary folks. So ideally, at least in my mind, it would be something that would be offered to everyone, including cisgender folks.
00:04:14
Speaker
But for now, it's very much um focused on trans and non-binary folks. Why, when you're saying about focusing on trans and non-binary folks to begin with, why are these benefits so important for trans and non-binary people when it comes to sort of healthcare equity?
00:04:33
Speaker
Yeah, it's critical because oftentimes these procedures, if they're not covered by public health, then that comes out of the pocket of the individual.
00:04:44
Speaker
And for some, that might be possible, especially if it's, say, a lower cost item like hormone replacement therapies that Those can range in costs per month, um you know anywhere from $15 $30, $50 a month.
00:05:02
Speaker
Maybe that's affordable for some folks, but for some, it's not. And that's where, especially if there's multiple procedures that aren't covered, now it's starting to add up in a way that becomes inaccessible to many trans and non-binary folks.
00:05:18
Speaker
especially when we think about the realities of of a lot of trans and non-binary folks are um disproportionately part of lower socioeconomic brackets. So they're just, the affordability is a huge consideration.
00:05:31
Speaker
And if they don't have access to that care, then has definite physical and mental health impacts on them and can make things much more difficult. And it's then harder to show up at work and to be you know, one's full, productive, um you know, integrated person. So that's where this type of care is so important, especially providing access to it.
00:05:54
Speaker
How common is it for ah insurance companies to include these benefits and in their plans that people can see at work? It's definitely becoming a um better known that this is something important and that it's an option available for folks to add.
00:06:12
Speaker
Insurance companies are understanding that they can explicitly offer it, not just, you know, kind of have people figure it out on their own, but actually put a package together that people, that organizations can add.
00:06:28
Speaker
And so more and more organizations are adding this into, especially if there's low or no cost associated with it. It's just like a no brainer, especially no cost. Like, why not? Right.
Typical Coverage in Health Plans
00:06:40
Speaker
absolutely And so especially as more and more employees inquire about it um or they come to know about it in some other way, maybe like this podcast and just inquire.
00:06:52
Speaker
And then, you know, add. So we don't have the exact stats, but we will. I mean, the one thing is that we get a lot more questions about it over the years. I would say in the last, especially the last three years, we have many more organizations coming um to us to say, hey, we're thinking of adding this as an option. what are some of the considerations? And we kind of accompany them in that journey.
00:07:16
Speaker
Sorry, what was that? That's great that more more companies are thinking about it and it's sort of progressing. I love that. Yeah. What, what kind of um care is typically covered then when you're working with these organizations and they're asking you like, what should we be considering?
00:07:33
Speaker
What kind of things do you see? Yeah, there's a whole bunch of things that are not covered by public health care. Often these are described as cosmetic procedures. So there's a bit of a value judgment as to they're kind of nice to have versus like critically necessary.
00:07:53
Speaker
um right They're necessary not just from the standpoint of the individual who would need them to feel themselves, but but also from a societal perspective if they you know we have certain expectations in our society for how somebody should look a particular gender and people either feel they need to or they want to um to be able to kind navigate life in a safe way and so think about something as concrete as
00:08:24
Speaker
um laser hair removal for many, especially trans feminine folk, that's a really important procedure um because unfortunately we don't have a lot of space in our society for women or feminine folk to have facial hair.
00:08:40
Speaker
um And so as a result, that's something that they're wanting to remove. And if they don't, that they get a lot more questions, comments, there's even barred access to ah women's spaces. And so it just really becomes complicated um and difficult for them.
00:08:59
Speaker
And so those those types of procedures are really ah critical. ah There's also hormone replacement therapies, which are typically not covered ah by public um health, unless you're under a certain economic bracket.
00:09:13
Speaker
then it is covered. I'm thinking especially in BC, pharma, pharma care and whatnot. um There's also things like vocal surgeries. So especially for trans feminine folk, unfortunately, just taking hormones won't change one's voice.
00:09:31
Speaker
ah So it won't make it a higher pitch. It is the other way, but not for for trans feminine folks. So that um either vo vocal lessens to increase the pitch or the height in the pitch, or ah vocal surgery is really key, but again, not offered because it's considered cosmetic.
00:09:51
Speaker
ah There are various other, not necessarily medical procedures, but more on the mental health side, the um you know ongoing support to access therapy ah counselors to help not just with figuring out one's own gender, which is an important part of the journey, but even after coming out, there are various societal challenges that folks face.
00:10:15
Speaker
And it's really helpful to be able to talk to somebody who is licensed as well as equipped to talk about gender diversity
Barriers in Accessing Gender-Affirming Care
00:10:23
Speaker
issues. so And having extra money to put to that makes a huge difference for people to be able to navigate.
00:10:32
Speaker
So there's a kind of a blend of different offerings there that are included in these types of benefits packages. You mentioned in the intro sort of about how these are seen as sort of add-ons rather than just like as a standard part of it.
00:10:49
Speaker
And I really wanted you to go into that a bit more because there are some limitations when it comes to that. And and it's when you're seeing this as a sort of special add-on rather than sort of a part of and a standard package. Could you talk about that?
00:11:03
Speaker
Yeah, it's so true that if it's kind of this add-on, then the organization has to know about it, number one, ask about it, add it. You know, there's like so many steps to actually doing it rather than just understanding as...
00:11:19
Speaker
trans people are a regular part of society and that just because of that, of course, we would add that into the mix. Certainly, maybe we'll get there.
00:11:30
Speaker
i think probably for now, because there, in some instances, an added cost there's the the idea that organizations need to be aware of that they're taking on this extra cost, right?
00:11:43
Speaker
um So that's why it's extra. There's a few other reasons why, and that's why it gets a little more complicated um because in some instances, because it's a separate thing, there's also layers of, you know, requirements to access those benefits as well.
00:12:01
Speaker
um And, know, Yeah. And that tension is always there in the medical field more generally. It's not just specific to insurance providers. There's this kind of, is you know trans health just part of regular health or is it so special that it needs to be its separate thing?
00:12:20
Speaker
Right. Yeah.
00:12:23
Speaker
I'll give you one guess as to where I think it is. But, um you know, it okay, there are certain aspects that I can appreciate require a degree of specialty, especially when you get to the surgical aspects, no doubt.
00:12:39
Speaker
But when it comes to kind of more everyday, especially hormone therapies and and whatnot, that's where there's not as much specialization needed. needed um even though for some it feels out of their depth, but once they get into it, they realize, okay, it's not too terribly out of their depth, right? So, I mean, that's a kind of roundabout way of saying that for now, insurance companies treat it as separate, but I imagine as we carry on um and people realize the the benefits more generally, hopefully we can have that be a more general offering within the insurance suite.
00:13:15
Speaker
Yeah. You also mentioned a little bit earlier about limits to access. And at least in my in my benefits package that I have, you need a diagnosis of gender dysphoria in order to access gender affirming care.
00:13:31
Speaker
And i I would imagine you have some thoughts on that. Oh, yeah. So what are those? What are the thoughts? Yeah. So with gender affirming care, um or at least to be able to access those benefits, there is often a requirement of a diagnosis.
00:13:51
Speaker
And that's a pretty general approach that insurance takes. So I don't think it's like they're specifically targeting gender affirming care and treating it in this way. It's I think most times that this is offered, there's something extra that you have to do to get that. So I understand it on one hand.
00:14:11
Speaker
And then on the other hand, unfortunately, there's just so many complicating factors to getting that diagnosis. And for some, they don't feel the need to get that diagnosis. Like there's a kind of a pathologizing of trans and non-binary folks to be able to access kind of basic care.
00:14:31
Speaker
And that for many feels very um difficult. Like there's nothing wrong with me to, so you know, like, and to kind of do these fancy hoop jumpings to, for whom, you know, feels off and also the cost of it, right. Especially there are public pathways to get a diagnosis of gender dysphoria.
00:14:54
Speaker
However, usually you have to be pursuing some form of that's covered by the province, which are usually major procedures. um top and lower surgeries, for example. And but some people don't want to get those surgeries. So now they're left with a private pathway of getting that diagnosis, which depending on the therapist you go to will require several sessions, you know, ask all kinds of questions. Some of them feel very invasive.
00:15:23
Speaker
People are asking about all kinds of stuff. um And more of that was in the pat in the past, but it still continues to some degree into the present. Things like, you know, relationships with other people, how you have sex, like other mental health diagnosis. Do you have, you know, what kind of medications are, it's just like on and on. It's just very invasive.
00:15:43
Speaker
um And so that feels like a lot for what kind of benefit that person is trying to access and within the benefits package.
00:15:54
Speaker
So if they're just trying to get mental health support, it feels like very long way around to get that access, right? And super relevant as well. all that And you probably need therapy after having done diagnosis.
00:16:11
Speaker
It's just like, it's so wild sometimes the hoops that the lengths that trans and non-binary folks have to go and this kind of bending over backwards to figure to to get some way to get something. Yeah.
00:16:25
Speaker
yeah So I try to say, you let's tie the diagnosis to more major procedures. Like if you're getting facial feminization, sure, you would want to have a bit more there to understand the exact need of that patient, right?
00:16:44
Speaker
um But if somebody is trying to access hormone therapies, we don't need this rigmarole, right? Yeah. Um, or if they're wanting mental health supports, absolutely should have no to like for me, no barriers, right?
00:16:57
Speaker
Just yeah automatically.
Vision for an Inclusive Healthcare System
00:17:00
Speaker
yeah if If we were to live, you know I ask this question every now and then, if we were to live in a fantasy world that was very trans inclusive, what would genuinely, truly gender affirming healthcare plans look like?
00:17:16
Speaker
Well, I pan out further in that I want it for everybody. This is easy, right? There are cisgender people who are wanting, you know, who need hormone therapy, you know, like there are people who want to have a a chest reduction, you know, like just there's so many different needs out there that if we were to broaden them and not have them be so hyper focused on trans and non-binary folks,
00:17:46
Speaker
I think it would make it that much easier because then you're not having to kind of gatekeep that access. It's just given to anyone who needs it. And guess who identifies the need?
00:17:58
Speaker
The person themselves. think And then it's great done. And it's not this kind of like, oh, well, do you really need it? yeah, You know, it could it be something else. And, you know, this kind of second guessing people, um people have been through enough to and I would imagine to cisgender folks who have similar needs also get ah sometimes some flack to write.
00:18:23
Speaker
um you know, rather than just trusting that they know what they need and here's the options available to them and they self-select. I mean, maybe that's being a bit naive, but I don't know. It seems pretty simple. is it Yeah, I don't think it is. Like, I think that's, it makes me think of like how,
00:18:42
Speaker
So like you just not trusted that you're an adult who can make decisions for yourself. If I think about, for example, cisgender woman who want to get hysterectomy and they haven't had children, there's this like jumping through hoops to to prove that you know yourself or that you can make decisions for yourself. Like you don't need to be diagnosed with anything. You can just say, this doesn't work for me. And I would like this, please.
00:19:01
Speaker
Like that's enough or should be enough that you know yourself. So yeah why not extend this? And then, you know, kind of wanting them to, you know, take time to really think it through. And so they won't regret it. if they haven't.
00:19:19
Speaker
Well, that too, right? Usually this is not like some whimsical thing you wake up and you're like, ah, that's it. Get rid of them. ah No, like there's usually, yeah a really solid basis, well thought out. And, you know, this this whole concept of regret, you know, I appreciate it and some on one hand and the other, it hopefully doesn't bar people who have genuinely thought about it, you know?
Guidance for Organizations on Inclusive Benefits
00:19:45
Speaker
Mm-hmm. um So if an organization doesn't have this in place yet, what kinds of things could they be looking to do next? Like if they want to put that in place? yeah Yeah. Yeah.
00:19:57
Speaker
And to to join with the other organizations that have already done it, I think it's a great idea. And, you know, there's a few different steps that organizations can take. um We'll have these outlined in a resource that we'll have linked ah so you can check it out in the show notes.
00:20:14
Speaker
But essentially it is important helpful to reach out to one's provider. A lot of them, if not most of them now have gender affirming benefits care packages. So it's pretty straightforward to say I would like to, and then figure out how you're going add it.
00:20:28
Speaker
I think the key thing besides just getting the gender affirming care benefits is to look at, you know, what are requirements or what does it include? What does it not include?
00:20:40
Speaker
Just so you're very clear from the outset to make sure you're getting as much as possible. um Sometimes, for example, facial feminization surgeries are not included in gender affirming care benefits.
00:20:53
Speaker
um And then they're also not covered publicly. So it puts people in a real bind. So these are really important procedures as making sure that they're in the benefits package. Also, if you can push back on the gender dysphoria diagnosis, especially for access to mental health care, um think that's really important. Even if it doesn't go anywhere,
00:21:13
Speaker
Most often the insurance companies are listing listening and documenting where there's pushback and they will change things. We've seen this. We've worked with insurance companies who come to us and say, ah bunch of our clients are not really happy with what we've done. what do you think we should do? So I very much invite you to to to say something, you know, um and maybe it won't change things right away, but maybe it'll give food for thought.
00:21:38
Speaker
um And then it's about communicating that out to your employees as well. Because oftentimes organizations will just get the benefit and then not tell anybody. And so trans person will have to out themselves to access that benefit.
00:21:56
Speaker
And we wanna try to get people to be able to access it, whether they wanna share with their employer or not, that they're trans or non-binary. And so making a little info sheet Or perhaps the insurance company already has that and making that available, announcing it as well, you know, that this is a really exciting offering.
00:22:15
Speaker
um It often is not just about making sure trans and non-binary folks. It's actually a positive way to signal to cisgender folks that, you know we're an inclusive organization and we're thinking about what specific benefits people need and going out and getting those. And yeah, and then share showcasing that a bit.
00:22:35
Speaker
Could you tell us a bit more about the resource that we will link in the show notes? Right. Yes. So this is resource we've put together based on the most common questions we get from employers about how to you know get this um gender affirming care benefits, kind of outline what it entails, especially listing specific procedures, especially the ones that are not covered by the public health care system.
00:23:01
Speaker
ah and then giving people organizations options. So maybe it's about getting the extended healthcare benefits, but maybe especially if you're a small organization, that's not possible, which is understandable, especially if there's extra cost.
00:23:16
Speaker
And so there are healthcare spending accounts that can be used instead where people just allowing people to take that money that's been set aside for the the health care spending accounts and using that towards gender affirming care. Right. So but then just outlining that and describing that a bit more can be really helpful.
00:23:38
Speaker
So we just go through all that kind of detail so that you are equipped to have those conversations. whether with the extended healthcare benefits insurance provider or options within you know what is possible for your organization.
00:23:53
Speaker
And if you want any support along the way in terms of adding gender affirming care benefits to your current extended healthcare benefits package, ah then feel free to to reach out to us. You can book time with Nico just to go over what your needs are and then we can more carefully assess, you know, how we can support you essentially ah through this journey.
Conclusion and Impact on Employment Decisions
00:24:14
Speaker
But we're definitely here to help if that's something of need.
00:24:18
Speaker
Great. I will include a link to Nico's calendar in the show notes. um Thank you so much, Kai. This has been really interesting. Absolutely. Yeah, I'm glad we were able to talk through it to make employers aware of it, as of course, it's a really important need.
00:24:34
Speaker
And oftentimes, either it's there and it's complicated to get access to it, or it's not there, and then people are disappointed. But I will say you know, when we talk to trans and non-binary employees, it's what if there's gender affirming care benefits, this is a big topic of discussion.
00:24:53
Speaker
um And oftentimes some people will actually move jobs to go to a company that provides this type of care, especially if they really need it. And so it's a deciding factor and whether people will join a company or not, or yeah know go to a company that does provide it.
00:25:12
Speaker
um So it's an important consideration. Amazing. Well, thank you so much. Thank you. See you next week. All right. Bye for now.