Gender transition in the workplace: Ready for change?

Increasingly, major insurance companies are offering or integrating coverage for gender affirmation care, supplementing public insurance. This involvement signifies an evolving world. 

Are insurance representatives in a position to accelerate this evolution? 

Despite these positive announcements for the trans and non-binary population, exclusionary practices persist, at least according to data from the extensive Trans PULSE Canada survey. Despite higher education levels, trans or non-binary individuals struggle to secure positions paying over $80,000 per year (8% compared to 14% for all workers) and are more often (54% compared to 45%) in roles paying less than $30,000 per year, the study reports. 

The cost of coming out 

Psychologist Lou-Ann Morin encounters individuals who have undergone their gender transition within the confines of their home for years, fearing what coming out could cost them: "There are people with financial issues who think, 'I'll start my transition, but I'm so scared of losing my job that I'll at least make sure to save up before coming out.'" 

In the current work environment, Article 81.19 of the Act respecting labour standards requires managers not only to counter but also to prevent workplace harassment. Hence, overt opposition from them is relatively rare. However, Lou-Ann Morin notes that rejection can still be felt in the form of bureaucratic rigidities: "I've had some bad surprises where I thought it would go well, a lot of hassles, obstacles just to change a name in a file. There were administrative hurdles under the pretext that the system wasn't made for that." 

Abigaël Bouchard, a non-binary and transfeminine individual and board member of Trans Outaouais, learned that even when a directly affected and affirmed person, as in her case, requests insurance coverage from their union, even during negotiation periods, they sometimes still face refusals. "When I asked the question, the response was as if it was too expensive for the group, that it would substantially increase the price," recounts Abigaël Bouchard. 

Knowing how to guide 

Despite these challenges, experts note that the support of just one person, be it the immediate manager or an HR member, can make a significant difference in the adaptation climate. However, Olivia Baker, program manager and workplace trainer for Fondation Émergence, shares that managers can feel unprepared in the face of an unexpected transition revelation, even regarding insurance coverages they pay for. "What I remember hearing several times was about trans people saying: 'When I announced my transition, people were not at all prepared and had no idea what to do. I had to call my insurers myself to see what would be covered or not, because I had no internal answers,'" highlights Baker. 

Making the services offered to insured individuals more accessible would already help reduce confusion. However, the need to find knowledgeable resources isn't just for care under the new insurance coverages for gender transition expenses. Managers must be aware that many professionals who may encounter transitioning individuals will understand little or poorly their reality. 

A typical example of this issue is the request for hormones, which fall under drug insurance. In theory, they could be prescribed by a family doctor, like birth control pills. However, many doctors prefer to refer the patient to an endocrinologist, whose order encourages members to request a psychological diagnosis in such situations. The result? Some of psychologist Lou-Ann Morin's patients don't get the coveted authorization for one or two years, especially in rural areas. 

Having a family doctor or nurse for follow-up is also crucial. Most insurance companies require them to provide the "proof of gender dysphoria." However, Olivia Baker explains, the lack of understanding between treating physician and patient makes this step complicated and not conducive to disclosure. According to Trans PULSE Canada, only 47.5% of all Quebec trans or non-gendered individuals would feel comfortable discussing their transition with a caregiver, nurse, or doctor. 

A bit of psychology in all this? 

Charles Saint-Laurent, Regional Vice President of Business Development at Medavie Blue Cross, admits that online medical consultation solutions are poorly adapted to such requests: "This diagnosis is not established in a five-minute meeting with the doctor. It's long-term." 

Some general practitioners also require a psychological evaluation. Lou-Ann Morin states that a few meetings can suffice when the person demonstrates that they know what they want, understand the consequences, and seem ready to face what will undoubtedly be the most important transition of their life. But the professional must also, in her opinion, have the skills to accompany other aspects of this transition, which often lead to prolonged hesitations. 

The situation is even more ethically troubling when hesitations persist, but the budget is tight, reveals Lou-Ann Morin. "When someone comes and says, 'I don't know, I think I'd like to think about it,' but there's a monetary issue behind it, it becomes, 'yes, but I can't afford to pay a psychologist or sexologist to help me think for several sessions.' Then, it becomes a delicate issue," notes the professional. 

Becoming an agent of change 

But perhaps this is only the visible part of the transition, according to the Mental Health Commission, as for this population, successful gender affirmation transition would reduce the rate of suicidal ideation from 67% to 3%, much closer to the national average. 

Olivia Baker explains, however, that this transition does not happen in one step and that there are issues on both sides: "We know that trans people generally need more support because they can face several issues, generally, in terms of anxiety and depression, which can be related to hiding who they are or the rejection they experience because of who they are. In both cases, it can be difficult." 

For now, the responsibility of the broker or insurance agent facing these internal issues may seem to be limited to properly informing their clients about their products. Yet, Desjardins, one of the last to have designed coverage for gender transition care for Quebecers, shows that it is possible to go further. 

In addition to its insurance coverages, the insurer offers, upon request, training and tools aimed not only at preventing transphobic or homophobic attitudes among employees but also at helping managers stay informed of best practices.