As of July 1, federal employees will be able to claim up to $75,000 for gender-affirming procedures not covered by provincial or territorial health plans. To qualify for the benefit, applicants must be over 18, under the care of a physician for gender affirmation, and have exhausted all available provincial or territorial medical coverage. Prior approval and the completion of a “Gender Affirmation Application Form” by both the individual and their medical care provider must be submitted to the insurance company for review.
Gender affirming treatment can include hormone therapy, genital reconstruction, breast reconstruction, facial plastic surgery, speech therapy, laser hair removal, liposuction, tracheal shaves, feminization surgery, and implants to their buttocks. While many provinces already cover drugs required for cross-sex hormone therapy, and some provinces cover breast surgery implants or mastectomies, the benefit plan does not specify which procedures would be covered.
In August 2022, the Treasury Board Secretariat announced that it had reached an agreement with the unions to create a “renewed plan” at no additional cost to taxpayers. The plan includes comprehensive coverage for members in difficult life situations, including gender affirmation and automatic coverage for electrolysis. Other benefits have seen mild increases, such as mental health services, vision care, laser eye surgery, and smoking cessation. The plan also requires mandatory substitution from brand name drugs to generic, less expensive versions. The Public Service Health Care Plan is administered by Sun Life Financial currently, but as part of a competitive bid, the new claims will be processed by Canada Life Assurance Company.