The importance of gender-affirming care in the workplace

June 25, 2024

For plan members, sponsors and administrators

This article outlines the significance of gender-affirming benefits coverage in meeting the health needs of transgender and non-binary employees and their family members or dependants. While many employees still face gaps in coverage, it’s becoming more common for employers to offer comprehensive gender-affirming benefits.

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“Gender affirming care to me has been lifesaving,” says Elizabeth (she/her), a non-profit professional in Ontario, using a pseudonym to protect her identity.

Gender-affirming care enables and supports people to make physiological and social changes that are more consistent with their gender identity.1 It encompasses medical, nonmedical, surgical, and nonsurgical services, mental health care, and social support. 

“Having had access to surgery and my hormones literally has brought me a sense of calm and happiness within myself that I never thought I’d be able to access,” Elizabeth says.

She isn’t alone. Access to genderaffirming care can significantly contribute to the mental well-being of trans and non-binary employees. For example, one research study demonstrated that gender-affirming surgeries were associated with a 42% reduction in psychological distress and a 44% reduction in suicidal thoughts.2

“Accessing care has not always been easy or perfect, but despite that I am so grateful that I’ve had the opportunity to live life fully,” Elizabeth says. “Government healthcare unfortunately doesn’t cover all genderaffirming care so having insurance means that I am able to fill those gaps that the government doesn’t pay for.”

Tide turning on gender-affirming care coverage

A Pride at Work Canada survey in 2020 revealed at that time many organizations offered some gender-affirming benefits coverage for mental health supports and hormone therapy, but only 13% provided coverage for medical or surgical procedures beyond provincial coverage.

The tide seems to be turning in recent years with more and more employers offering comprehensive coverage for gender-affirming care. Later this year, Manulife Group Benefits is making gender-affirming benefits part of our standard extended health care coverage, giving 1.6 million Canadian workers (plus their dependants) access to gender-affirming benefits.

“Everyone deserves the opportunity to be their authentic self,” says Shawna M. Oliver, Head of Global Benefits and Wellness at Manulife. “For some, doing so may be done through outward expression. For others, there may be some clinical support needed. However they may get there, it’s essential we support each employee.” 

Manulife employees have gender-affirming care coverage as part of the employee benefits plan.

“When our employees feel comfortable and can excel, our customers thrive,” says Shawna.

Recommendations to support gender-affirmation in the workplace

The following recommendations were developed by Manulife in collaboration with Pride at Work Canada and Cleveland Clinic Canada to support organizations striving to support the needs of trans and non-binary employees.

1. Establish workplace policies and protocols to support transitions

Develop a policy and protocol for trans and non-binary inclusion in the workplace. Include a workplan that identifies key points of contact (e.g. Human Resources or Inclusion office) and details the steps for employees to follow when transitioning in the workplace, such as changing names and identity markers in workplace systems, accessing benefits, and taking leave for gender-affirming care.

According to the Transitioning Employers survey by Pride at Work Canada, 51% of the surveyed organizations have protocols for changes in name and identity markers, while only 39% have protocols for assisting employees in transition.3

Ensure the policy and protocols are introduced across the organization and communicated to employees throughout their employment. Resources include The 519’s Creating Authentic Spaces guide and Canadian Labour Congress’s Workers in Transition guide.

2. Provide comprehensive gender-affirming coverage

Offer comprehensive healthcare coverage for gender-affirming procedures and treatments, including medical treatments, medications, surgeries, and medical devices to support the specific healthcare needs of trans and non-binary employees and their family members or dependants.

In addition, consider coverage for a range of other health services that can support the gender-affirmation journey, including in-Canada travel (gender-affirming surgeries are not available in all provinces), comprehensive drug coverage, and gender-affirming voice therapy. 

Ensure to regularly communicate to all employees about your inclusive benefits, gender-affirming benefits, and gender transition policies. Promoting this information in job postings, during employee onboarding sessions, and through annual benefits and wellness communications are ways you can help ensure employees know how to access these benefits.

Also, let employees know that the investment in these benefits has a positive effect not only on the wellness of individuals, but on workplace culture as part of your wider inclusivity, engagement, and retention strategies.

“Many trans and non-binary individuals face barriers accessing gender-affirming care,” says Dr. Michelle Roseman (she/her) with Cleveland Clinic Canada, who is a family medicine physician with expertise in 2SLGBTQIA+ health care. “Employers can play a key role in supporting access to this vital care, which is associated with significant improvements in quality of life, mental health, and wellbeing among trans and non-binary people.” 

3. Provide access to adequate mental health coverage

Provide comprehensive mental health coverage to support employees on gender-affirmation journeys, including all types of mental health practitioners for a range of budgets and availabilities. Practitioners include psychologists, social workers, psychotherapists, psychoanalysts, counsellors, marriage and family therapists.

For more information on recommended mental health coverage read our article: Mental health concerns impact the workplace

4. Support social and legal affirmation

Employers play a role in supporting social affirmation by using an employee’s correct pronouns and refraining from deadnaming. Deadnaming occurs when people are referred to by their birth, given, or former name without their consent. Because legal records may not accurately reflect a person’s chosen name, gender identity, or both, employers can play an important role in ensuring that preferred names are used consistently.

Allow employees’ preferred names to appear publicly in workplace systems and keep an employee’s legal name confidential, as legal affirmation— the process of updating one’s legal documents and records—can be a lengthy and expensive process.

5. Establish gender-inclusive policies and facilities

Revise workplace policies to use gender-neutral language and to explicitly mention 2SLGBTQIA+ inclusion. Provide gender-neutral or all-gender washrooms and changing facilities in all work locations. Be sure to carefully consider signage, wording and washroom location to promote inclusion of all employees at all stages of transition, including those who may not have disclosed yet.

“Where organizations don’t own their workspaces, they’ll need to connect with their landlords to make these changes,” says Misha Goforth (she/her), Manager of Programs at Pride at Work Canada. “In our experience, when tenants join forces to advocate for gender-neutral facilities, it greatly increases their chances of getting support from their landlord.”

Fortunately, many organizations are making important progress with their washroom facilities. According to the survey by Pride at Work Canada, 74% of surveyed organizations have at least one all-gender washroom. 

6. Revise or remove dress codes

Allow employees to express themselves at work authentically and comfortably for the work they perform. According to the survey by Pride at Work Canada, 45% of employers surveyed had gender-inclusive dress codes or uniform policies.

7. Offer training and education

Provide training and resources for your employees to learn about trans and non-binary inclusion in the workplace.

In addition, offer specialized training for human resource specialists and people managers on supporting employees transitioning in the workplace, including guidance on respectful communication, accommodation of needs, and creating a supportive work environment during the transition process.

8. Build a supportive workplace culture

Encourage dialogue on trans and non-binary inclusion and promote pronoun sharing in the workplace, support employee resource groups, and provide professional development opportunities specifically for non-binary and transgender employees. 

If you have Manulife Group Benefits extended health care coverage …

Gender-affirming benefits will soon be included in our standard extended health care coverage.

Procedures covered include the following:

  • Transition-related genital and chest/breast surgeries that are not covered by the provincial/territorial health plan
  • Facial feminization/masculinization surgeries
  • Body feminization/masculinization surgeries (such as tracheal shave, liposuction, lipofilling)
  • Vocal cord surgery
  • Electrolysis or laser hair removal
  • Body hair or skin graft
  •  laser hair removal
  • Body hair or skin graft

Learn more about gender affirmation coverage.

Cultivating 2SLGBTQIA+ health in the workplace

The stories in this special report encourage you to consider how your employee benefits programs and company policies can support staff members from all backgrounds, genders, and identities.

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