A new gender-affirming care provision under the federal government’s employee health plan — a change touted as a major win for transgender plan members — has turned into an ongoing struggle for some trans workers who say they’re rethinking future surgeries because they’re already running into walls getting claims reimbursed.
The new provision under the Public Service Health Care Plan (PSHCP) came into effect in July 2023, at the same time Canada Life took over the plan’s administration.
Gender-affirming care encompasses a number of treatments, including mental health counselling, hormone replacement therapy, genital surgery, breast augmentation, pectoral implants and even something as basic as a haircut.
Plan members can have up to 80 per cent of each treatment covered, to a lifetime maximum of $75,000, for procedures performed in Canada but not covered by provincial or territorial health plans. It’s meant “to help people with their gender affirmation journey,” according to a government web page.
‘Constantly have to fight’
What should have been a year focusing on the surgeries that would transform her body to reflect how she sees herself has been been anything but, Alexandra Lamaute says.
“We constantly have to fight to receive something that should be much more simple,” said the 41-year-old who lives in Dieppe, N.B. and underwent breast augmentation and facial feminization surgery last year.
She was eventually reimbursed 80 per cent for those procedures after what she said felt like a constant demand to submit more and more information, but is still awaiting reimbursement totalling nearly $14,000 for a body feminization operation she underwent in April.
Lamaute said she is considering delaying, or simply not having, vocal surgery to make her voice sound more feminine because she’s worried she won’t get reimbursed.
“My voice doesn’t really match my appearance anymore,” she said, leading to people she deals with on the phone often calling her “sir” or “young man.”
“I don’t blame anyone, but it takes a toll after a while.”
I haven’t even been able to enjoy the process [of transitioning] or the journey because I’ve been so worried about dealing with Canada Life.– Amelia Hawk
New Brunswick does not cover procedures such as breast augmentation, facial feminization, tracheal shaving, hair removal and voice and communication training for those transitioning from male to female, according to the health ministry’s website.
Genital surgery, such as vaginoplasty, is covered.
Lamaute’s friend and fellow government worker, Amelia Hawk, who lives in Shediac, N.B., has experienced similar difficulties.
She said she was really excited by the plan change because she was initially going to pay for everything out of pocket.
The 42-year-old came out as transgender in January 2023 and began treatment a year later, an expensive transition, she said.
Hawk’s excitement quickly changed to frustration as some costs weren’t reimbursed, she said.
“I haven’t even been able to enjoy the process or the journey because I’ve been so worried about dealing with Canada Life,” she said.
Hawk almost cancelled her breast augmentation surgery last month because she wasn’t sure she could afford it and has begun liquidating some assets, she added.
While she did receive more than $6,500 last week to cover a portion of her breast augmentation, Canada Life won’t reimburse her for the cost of the operating room, leaving her on the hook for nearly $2,200 and also making her question whether to go ahead with further surgeries, like facial feminization, she said.
“I just want to get rid of my more masculine frame and just start feeling and looking like a female and just being my true authentic self,” Hawk said.
Neither Lamaute nor Hawk have come close to maxing out the $75,000 they’re entitled to, with Lamaute having been reimbursed $36,518.20 and Hawk receiving $6,586.12 so far.
Hawk and Lamaute also say Canada Life employees and supervisors have misgendered them by calling them by their former names, causing them further anguish.
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Required to use names government provides, Canada Life says
In an emailed statement, Canada Life said it deeply regrets that information provided by the government — which the company says it was required to use — led to the use of the wrong name.
The company said it’s working with the government to ensure plan members’ files accurately reflect people’s names and pronouns, a process it said should be completed by the end of the year.
As for coverage limits, those are decided by the government, Canada Life added.
According to Canada Life, when the gender-affirming care provision came into effect, the government decided not to include operating room and physician consultation fees, despite those being covered by other employer plans also administered by Canada Life.
CBC did not receive a response to the questions provided to the Treasury Board Secretariat of Canada by deadline.
Timely access to care critical, physician says
The sense of desperation both Hawk and Lamaute have expressed is not uncommon, according to Dr. Kate Greenaway, a family physician and medical director of the Foria Clinic, a virtual gender-affirming care practice treating patients in Ontario and Alberta.
“We know it’s a very critical moment for folks when they’re waiting for care, that the longer they wait, actually the worse mental health becomes, the worse that dysphoria could become,” she said.
Offering gender-affirming care through a private insurance plan is “absolutely life saving” for many people looking to transition because even one of the most common surgeries for trans women, breast augmentation, can cost several thousand dollars, Greenaway added.
“Then you look at other surgeries, which are actually quite a lot more expensive, but they may be necessary for someone to live in their affirmed gender [and] to live their life more freely and fully.”