As part of our ongoing commitment to helping plan members live their healthiest lives, Green Shield Canada (GSC) is excited to announce that, effective June 30, 2021, we will be including a gender affirmation offering as a standard benefit (ASO and non-refund) in all Group plans that provide extended health services coverage. This offering – another important step in delivering inclusive benefits coverage – enables plan sponsors to support plan members throughout their gender transition journey.
While traditional benefits plans address some components of the journey, we firmly believe that they fall short of covering the scope of transition needs. GSC’s offering steps in to reimburse expenses that are above and beyond typical plan designs.
Equally, the offering helps to fill the gaps tied to services not covered under provincial or territorial government health care plans. As a health and dental specialist, count on GSC to ensure that all government supports have been appropriately applied before we pay claims.
In developing this offering, GSC consulted with a wide range of organizations, including the Canadian Professional Association for Transgender Health (CPATH) and the World Professional Association of Transgender Health (WPATH), to strengthen our understanding of the gaps that exist today and the messaging that will resonate most effectively in the transgender community.
The details
As we shared in the December 2020 issue of The advantage®, there are two categories within our gender affirmation offering, and our standard approach will be to include both categories within all Group plans as of June 30, 2021:
- Foundation: Includes reimbursement for core surgeries not covered by provincial or territorial coverage and services that assist in the physical alignment of the individual’s transitioned gender. Examples include vocal surgery, tracheal shave, chest contouring/breast construction, vaginal dilators, facial feminization, and laser hair removal.
- Focused: Includes reimbursement for surgical enhancement of the individual’s features that follows their accepted gender ideal. Procedures include nose surgery, liposuction/lipofilling, face/eyelid lift, lip/cheek fillers, hair transplant/implants, and gluteal lift/implants.
Reimbursement of eligible expenses is subject to a diagnosis of “gender dysphoria” from a medical doctor, in addition to a reasonable and customary (R&C) fee per claim of $5,000 and an overall lifetime maximum of $10,000. These R&C fees are designed to strike a balance between reducing the cost burden on plan members and maintaining plan sustainability.
Breaking down the numbers
To provide additional context on what this offering could mean for benefits plans, we estimate that the impact will be less than 0.5 per cent of total health costs across GSC’s entire book of business.
- For ASO-funded groups, costs will flow through the extended health services experience.
- For non-refund and retention-funded groups, with this being a lifetime maximum benefit, the cost impact will be built into the extended health rate over time and across the book – resulting in minimal direct impact to each individual renewal.
Keep in mind too that, as mentioned above, plan members will be pointed to provincial programs first. If no provincial funding is available, they will turn to their benefits plan.
Next steps for plan sponsors
Stay tuned for sample materials to help you promote the gender affirmation offering to your plan members in the build-up to the launch date.
While our thorough product development process confirmed the value of making this a standard GSC offering, please note that you still have the ability to opt out. If you decide that you do not wish to offer this option to your plan members, or you have questions about the offering, contact your account team by June 11, 2021.
