How can employers support staff with gender dysphoria?
Gender dysphoria is currently a hot topic of discussion across the private healthcare market. It has already been reported that demand for transgender healthcare is expected to accelerate.
In fact, Dr James Palmer, the Medical Director for specialised services at NHS England said that referrals to adult services have increased by 240% over the last five years and nearly two million Britons could question their gender in the coming years. In the future he expects up to 3% of the population to make contact with transgender health services at some point in their lives.1
So what is gender dysphoria?
Gender dysphoria, sometimes known as gender identity disorder (GID), is a diagnosable medical condition, where a person experiences discomfort and distress because of a mismatch between their biological sex (assigned at birth) and their gender identity (the gender a person identifies with).
There are no physical symptoms of gender dysphoria, but people may experience and display a range of feelings and behaviours. In some cases, medical treatment is appropriate and aims to help people live the way they want to, in their preferred gender identity.
Gender dysphoria treatment
Gender reassignment can be a very lengthy process, often taking years from the initial consultation to completion of treatment. There can also be a wide range of supporting treatments and ongoing drugs in addition to the surgical requirements.
Adults with gender dysphoria should be referred to a Gender Identity Clinic. But with only 8 NHS commissioned Gender Identity Clinics, there can be up to a two-year wait following GP referral. These clinics offer ongoing assessments, treatments and the appropriate support and advice for people with gender dysphoria.
The NHS guidelines state that the individual will have to live as their chosen gender role for at least two years and then satisfy the Gender Recognition Panel that they intend to do so for the rest of their lives. They will then be eligible to proceed with surgery.
However, there is no defined treatment pathway and the gender dysphoria treatment chosen will vary from person to person. Some trans individuals will live permanently in the gender role that is most comfortable for them without ever seeking medical treatment. In many cases people who are experiencing transgenderism have a combination of hormone medication and surgery. The social gender role transition is usually completed within 2 years and surgery can be considered to permanently alter a person’s sex.
What are other employers doing to support staff with gender dysphoria?
Employers are striving to be diverse and inclusive towards their staff. And employees who feel supported and able to be their authentic selves, are less likely to suffer stress and anxiety that can lead to mental health issues.
Mercer has already announced that they now offer trans benefits for treatment of gender dysphoria as part of its UK employee private medical insurance scheme. This incorporates comprehensive cover for gender dysphoria including consultations, diagnosis, mental health and surgical treatment.
The insurance industry is already responding to demand from larger organisations to develop products that include treatment for gender dysphoria. The options available vary from provider to provider. For example, some will offer optional benefits to larger corporate clients who are either self-funded (via a healthcare trust or cost plus type funding arrangement), or are fully insured but of a sufficient size to cover the additional claims cost.
Most providers have started to include benefits for gender dysphoria, focusing on either the physiological or surgical aspects of treatment, in some cases both. But they have stated any cases will have to follow the NHS guidelines before surgery is authorised, which includes two years of psychological adjustment and hormone therapy.
However, some insurers believe that further due diligence is required to understand the skills and expertise of private surgical facilities, including how they are regulated and how their services interact with the NHS to ensure continuity of care, should the member’s private healthcare benefit cease.
Although gender dysphoria is an increasingly popular topic there are still a lot of unanswered questions and the full cost of treatment is relatively unknown.
Employers looking to offer benefits for employees with gender dysphoria should be aware of the possible requirements for ongoing treatment for this patient group, such as psychological support to treatment of complications. Also, you must be clear on the level of cover available under any benefit including guidance on underwriting, any operational constraints to NHS transfer and family cover.
Unfortunately, we are a way off yet from insurers offering universal and blanket coverage of gender dysphoria and other associated conditions. However, progress is being made towards the inclusion of gender confirmation benefits to corporate healthcare plans. It is important for employers to obtain expert input to ensure their benefit structures are consistent with the level of support they plan to offer, as well as the overall message they wish to convey to their employees.
1 Health Insurance Daily ‘In the spotlight: Transgender and gender identification’, Dec 2018
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