In June 2017, the federal government amended the Canadian Human Rights Act to strengthen protections against employment discrimination for LGBTQ+ individuals, forbidding employers across all jurisdictions to discriminate on the basis of sexual orientation, gender identity or gender expression.
While the protections and language used by organizations can vary, the intent of the protections is that insurance policies can’t discriminate on these bases, says Susan Ursel, a senior partner at Ursel Phillips Fellows Hopkinson LLP.
In a recent survey conducted by Pride at Work Canada, most employers indicated their benefits plans are inclusive of LGBTQ+ individuals. But when probed further on the topic, this essentially meant they only extended benefits to their plan members’ same-sex partners.
“To not extend benefits to same-sex partners in today’s day and age is, in fact, against the law,” says Colin Druhan, executive director of Pride at Work Canada. “And the absence of legal infractions does not an inclusive employer make.”
Many employers don’t understand the negative health outcomes prevalent among LGBTQ+ people, he adds, so access to the same group benefits as other employees is vital because these individuals already face a lot of barriers due to stigma and discrimination.
Druhan says heterosexism and homophobia are rampant in the health-care community, and LGBTQ+ people aren’t treated as well as other patients because of their sexual orientation or identity, which can result in incorrect assumptions about queerness and one’s associated behaviour. “[LGBTQ+ people] haven’t had great interactions with medical providers in the past, making them reticent to seek the help they might require.”
Anything employers can do to eradicate those barriers and encourage better health outcomes for LGBTQ+ individuals is better for the workplace, as well as Canadian society at large, he says, noting unhealthy population groups impact everyone’s well-being. “Offering LGBTQ+ coverage allows employers to keep their workforce fit and productive. And when people are happy and healthy, they’re able to work, make money and participate in the economy.”
Free to be me
As a baseline, employers have to cultivate a working environment that’s LGBTQ+ positive, where prejudice isn’t tolerated whatsoever, says Neil Iddon, director of the benefits practice at Toronto-based consultancy Associum.
Demonstrating a respectful and supportive environment for LGBTQ+ individuals factors into recruiting the best possible talent, especially in major urban areas, says Joan Weir, director of health and dental policy at the Canadian Life and Health Insurance Association. Employers want equity among all of their employees, she adds, and to provide them with the ability to access the benefits they require.
The inclusion of LGBTQ+ people in group benefits plan coverage has a powerful effect on making organizations more welcoming, says Ursel. “Offering a suite of benefits to LGBTQ+ people is not only non-discriminatory but creates an atmosphere in which all employees feel valued.”
However, the market is demand-driven, says Iddon, noting insurance companies are only as proactive as their plan sponsor clients. He believes employers’ willingness to emphasize their support for LGBTQ+ employees will drive the products and policies that carriers offer. “It starts with the employer and how open they are.”
Druhan suggests that plan sponsors benchmark what they’re doing against the industry’s best standards and assess their offerings based on factual knowledge from health-care providers, LGBTQ+ organizations and professionals in the space as opposed to their own assumptions. A benefits plan’s language should also reflect all of the different individuals who might access its care, he adds.
“If people don’t see themselves in that language, they won’t see the benefits or know what’s available to them — and then companies wind up spending money on plans that only help a chosen few and could potentially alienate talent within the workforce.”
Above and beyond
Within group benefits, there are several options to help LGBTQ+ employees feel welcome.
Employee assistance programs include services, such as counselling, that are directed toward LGBTQ+ people and their dependants. “If organizations show these members support by offering counselling for them and their dependants, they’re more likely to retain that person as an employee,” says Iddon.
As well, medical supports are available for people who are gender diverse or exploring their gender identity and expression, says Druhan. “Being able to go to your employer and hear, ‘We know how to help you and here are some suggestions about health-care providers who know what you’re going through,’ is an opportunity to help employees and support their dependants.”
And, although more progress is required, some companies are beginning to give complex LGBTQ+ life events the attention they deserve.
In April 2019, Sun Life Financial introduced gender affirmation coverage, available through its extended health-care benefits plan. Marie-Chantal Côté, the insurer’s vice-president of market development, says the company was seeing a growing interest for this type of coverage from plan sponsors nationwide. Internally, Sun Life felt it was important to keep developing solutions to align with employees’ diverse needs.
“There’s a significant impact on folks’ mental, emotional and physical well-being when they don’t feel connected to their gender,” she says. “Transitioning is a critical moment and plan sponsors need to provide solutions to support these individuals.”
Sun Life offers two types of gender affirmation coverage, which are meant to work in tandem with provincial programs. Core coverage includes basic surgical procedures not covered under provincial health-care plans, like Adam’s apple reduction or voice surgery, while extended coverage includes surgical procedures to align feminine or masculine features with the transitioned gender, like facial bone reduction or cheek augmentation. “It’s important for plan sponsors to offer LGBTQ+ coverage because the data shows embracing diversity and inclusion brings creativity, innovation and also drives value, as well as measurable outcomes,” says Côté.
KPMG Canada added gender affirmation as an enhancement to its benefits plan in December 2018. “Offering an enhanced gender affirmation benefit is critical to supporting the health and well-being of our employees and their families,” says Stephanie Braid, the company’s senior manager of inclusion and diversity.
“Gender is not binary, and helping our people feel comfortable and supported to live openly as their authentic selves is essential to creating an inclusive workplace where our people feel they belong. If organizations can’t afford to offer a gender affirmation benefit, they can still take steps towards building inclusion by educating their workforces about the diversity of gender identity, including the importance of asking for and using a person’s pronouns.”
Indeed, expanding coverage may be challenging for small- to mid-sized organizations that typically have off-the-shelf insured products, says Weir. But before employers assume they can’t afford to offer LGBTQ+ coverage, they should talk to their insurance companies to understand the difference in premiums based on their experience ratings, says Ursel. “Even if a certain product isn’t available, the fact that employers are enquiring will cause insurers to put their minds to new markets that want to offer a suite of benefits for LGBTQ+ employees.”
Cost makes it all the more important for smaller employers to scrutinize their plan’s need and usage, says Druhan. If there isn’t enough coverage in a certain area, some companies provide top-ups. Flexible options are also beneficial, he adds, noting offering 20 per cent more on top of overall spend for full access to gender transition-related or prescription drug care is a great thing to do if employees are going to use it.
And Ursel suggests the health-care system engage with insurance companies to explain the idea of medical necessity and so-called ‘cosmetic’ surgeries like laser hair removal, chest contouring, breast enhancement and tracheal shaving. While some insurers may view these procedures as elective and non-therapeutic, cosmetic surgeries do more than just alter someone’s appearance to look a certain way, she adds.
For transgender people, appearance-altering surgeries and other therapies are medical necessities for well-being and can lead to overall health improvements. “These procedures may have a fundamental impact on the mental health of trans employees by improving their felt and lived sense of congruity with their gender.”
Miles more to go
Despite progress in certain areas, other issues affecting the LGBTQ+ community are falling by the wayside because of the misapprehension that they’ve already been fully addressed. For example, people talk about HIV/AIDS being eradicated or a non-issue, says Druhan, but this couldn’t be further from the truth in Canada.
In December 2019, a report by the Public Health Agency of Canada found the number of new HIV cases in Canada increased 25.3 per cent between 2014 and 2018. Currently, more than 68,000 Canadians are living with HIV.
Prescription drug coverage is crucial, notes Druhan, especially when looking at how much some medications or hormone therapies can cost.
While most private insurers cover HIV/AIDS medications, like pre- or post-exposure prophylaxis, says Weir, these would fall under conventional prescription drug plan design requirements, which means the employee would be required to pay a coinsurance.
Since Canada’s universal health care doesn’t include drugs, robust coverage through an employer’s benefits plan is significant, says Druhan. “If an individual with HIV/AIDS is constantly worried they won’t be able to afford their medication, this is something that will take them away from their job. And that kind of stress causes mental-health issues additional to the physical ones.”
Indeed, ensuring LGBTQ+ employees receive the best support their employers can offer them through comprehensive benefits plans means they’re going to be healthier and will potentially experience fewer mental-health challenges.
Druhan also highlights the significant amounts of phobic, post-traumatic stress and anxiety disorders prevalent among LGBTQ+ individuals. “If an employer focuses on the folks that need it most, their workforce is going to succeed, whereas other organizations might have higher rates of absenteeism and turnover.”
Cassandra Williamson-Hopp is conference editor at Benefits Canada.