Your approach, grounded in your Inclusion and Diversity strategy and supported by your Employee Assistance Program, is vital to your employees’ ongoing wellbeing – not only for those embarking on a transition journey but also people identifying as gender diverse.
WTW is seeing a significant uptick in enquiries from clients on gender affirmation. They’re seeking to understand what the Australian public and private health insurance programs will cover.
Ultimately, health funds can only pay benefits for surgical procedures where there is a recognised Medicare Benefit Scheme (MBS) item number used by the Provider, and an appropriate medical diagnosis for the patient’s admission applies. It’s important to note that a 12-month waiting period may apply. Where there is no valid MBS item number, the procedure is considered cosmetic and no benefits will be paid, depending on the level of hospital cover in place.
Outpatient items must also be considered, such as GP and Specialist consultations, and hormone supplements. These could be reimbursed, depending on your employee’s health fund cover, through Medicare, or access to the Pharmaceutical Benefits Scheme.
If you have an employee on a gender transition journey, know that not everyone has surgery or the same types of surgery. Adding to the complexity is that MBS item numbers for the same procedure may vary depending on their surgeon, and doctors can charge a fee above and beyond the MBS schedule cost.
WTW strongly recommends you advise your employee to request a fully informed financial consent document from their doctor before beginning any treatment. Once this is provided to a private health insurer, assistance can be given to understand what benefits may be payable under their cover, or as part of a Medicare claim along with understanding out of pocket costs.
Health funds continue to advocate within the industry, by pushing for Medicare system reforms, to ensure people feel better represented. Some funds allow selection of the pronoun ‘Mx’ when members enrol, and people can contact customer teams to nominate how they wish to be identified. However, people are still required to choose male or female in line with the sex assigned at birth, to match with Medicare details.
There are several ways WTW assists organisations to offer support for LGBT+ employees, concentrating on mental, physical and financial wellbeing programs, augmented by education and training.