Gender-affirming care boosted in new federal worker health plan

A recent change in health-carebenefitsfor federal civil servants will cover more costs for gender-affirming care, but one of the largest federal unions still has concerns.

On July 1, the country's largest health-care plan switched providers to Canada Life Assurance Company, bringing more than 1.7 million federal public servants, retirees and their dependents with them.

Workers covered by the Public Service Health Care Plan (PSHCP) are entitled to a maximum reimbursement of $75,000, reimbursed at 80 per cent, for "certain gender-affirming procedures not covered by provincial/territorial health plans to help people with their gender affirmation journey" performed in Canada, according to a government web page.

For example, in Quebec, hormone therapy is covered by the provincial drug plan, as are other surgeries such as first stage mastectomy, vaginoplasty and phalloplasty.

In Ontario, coverage only covers pectoral and genital surgeries.

• Gender-affirming care: What it means and why it's in the news

For a person to be eligible they also must:

• Be 18 years or older.
• Beunder the care of a doctor for gender affirmation.
• Have exhausted all the coverage offered by their province or territory of residence.
• Have undergone all procedures considered medically necessary by the attending physician or nurse practitioner.
• Obtained pre-approval by completing a gender affirmation request form to the plan administrator.

Help for his electrolysis

Gabriel Lanthier began the first steps in his transition about six years ago.

By then he'd been a civil servant for several years. He was able to benefit from procedures covered provincially like chest surgery and a hysterectomyto remove the uterus.

The next big step is phalloplasty, a three-step procedure that will use skin from Lanthier's forearmto createthe penis. While that'scovered in Quebec, forearm electrolysis an essential step that involves removing arm hair first to avoid any complications is not.

Lanthier said he's already paid about $4,000 out of pocket for the electrolysis,but expects to have the remaining work covered.

"I would have liked it to happen a little earlier, but I am happy that there is progress," Lanthier told Radio-Canada in French.

He said he thinks the changes send a message.

"If more and more employers have [this coverage], it gives you the power to talk to the provinces and territories and ask them to have equitable coverage for everyone."

Accessing doctor could be hard

Trans Outaouais, an organization that supports transgender people in that Quebecregion,noted more and more employers have been offering this type of coverage.

Abigal Bouchardof the group's board of directors believes the federal plan will make a difference in coveringprovincial gaps.

"It demonstrates the desire to take into account the needs of trans or non-binary people who are employees," Bouchard said in French.

To obtain coverage, the insurer requires a diagnosis of gender dysphoria, the feeling of discomfort or distress a person may feel when the gender they were assumed to be at birthdoesn't match their gender identity.

Since accessing a doctor can bedifficult, it could be hard to get that diagnosis, Bouchardadded.

Elements to clarify, says union

The president of the Professional Institute of the Public Service of Canada, the second-largest union representing federal public servants, said there are still things to clarify.

"We don't know what the plan will specifically cover," said Jennifer Carr,"and we want to make sure that we monitor to make sure that it is doing what it is intended to."

Carr also fears that transgenderpeople will have to continue to pay large sums of money even afterinsurancefor things liketravel costs.

"If you are in the west coast and the only surgery that a surgeon that does that is in Montreal, that is a barrier," she said.