It's well known that gender identity issues have fallen under the scope of mental health. The recent media activity around the subject has brought it into mainstream awareness.

From 1 January 2020, the WHO updated their ICD (International Classification of Disease) to version 11 and put it online with exciting changes.

Part of this update moved gender dysphoria/incongruence under sexual health, which changes the landscape of how this will be treated for those who are transgender.

For those that haven't clicked on what this means, transgender is now a defined sexual health medical condition. It is no longer considered a mental health condition.

This will have interesting ramifications for health care and, more specifically, medical insurance.

New Zealand Medical Insurance

At this stage, the only insurer that has said anything is Partners Life. They still have not said anything official about their approach. However, we have clients with coverage and claims paid for gender dysphoria.

• It is now a covered and paid condition with medical insurance in New Zealand, just not all of them.

From my discussions with Partners Life, following communication in the transgender community, the change in designation means that existing policyholders who have gender incongruence that needs addressing surgically will be able to access surgery.

• The caveat is that they were under 16 when they took cover (or, more to the point, their parents took cover on them).
• This means they can access private medical support for their medical needs including surgery.
• There is still the disclosure question of awareness before the cover was applied for, which may be a point only discovered at claim time.

As you may have gathered, this only opens the door for some.

• Those aware of their situation or looking to take cover now that this definition has changed will face challenges with getting claims paid.
• If you are over 16, when the cover was taken, there is no cover for gender dysmorphia.

The activity of applying for cover when you don't have an official diagnosis but you know something is going on is called anti-selection, and insurers don't like it much.

Those that already have medical insurance

Those that already have existing medical coverage and who are transgender should remain where they are on their current policy.

This is for two reasons:

1. While Partners Life has been positive on the changes early in the piece, the rest of the medical insurers may also respond in time. People need some patience to not stuff up their coverage by moving anywhere.
2. As already stated, the awareness and being over the age of 16 means that moving to Partners Life won't deliver what you are looking for with gender affirming treatment.

What is certain is that moving coverage while being aware of your gender identity condition will be held against you with the new provider.

What's the future for other providers?

It is likely, with time, that all insurers will provide cover for existing policyholders needing gender reassignment surgery.

• We have seen this with many things; unfunded cancer medicines being an obvious one that started back in 2002/2003 with Sovereign and is now provided by all of the leading providers at some level.
• But not all policies have this baked in, though for many policyholders this is now an add-on that can be applied for on existing policies.

New clients to insurers will likely face additional questions and exclusion relating to gender issues because of the change in diagnostic criteria.

• Presently Partners Life have stated they are not asking additional questions about gender dysphoria because it doesn't add to their underwriting approach. Again the age 16 line they have communicated to us.
• What this means for those over age 16 is the lack of questions from Partners Life, and the resulting lack of exclusions, does not convey coverage for gender dysphoria.

The social challenge of this change:

This stance is likely to be seen as quite divisive in the transgender community. It does create a level of have's and have not's, which is unfortunate, but also unavoidable with how insurers work.

• The reality, given time, insurers will look to cover this, and it will likely take a generation, or two, for it to settle down as it has done for unfunded medicines.

The points strongly stated by Partners Life to me;

• they are looking to provide support for genuine cases for their long-standing policyholders, where this is something that has developed through that client's journey.
• They aren't prepared to take on existing adults applying for cover just to have this surgery.
• Thus the age they have defined and the non-invasive approach to gathering information on application forms.

This is pretty forthright and fair from an insurer.

• And before we get into beating up insurers about how unfair this might be to existing adults, take a breath and appreciate that this stance is significantly more of a response than our government and health system provides.

From my 20-plus years in insurance, I'm surprised that any insurer has stepped up and taken this stance, we we are very lucky in having Partners Life take this stance

• And Partners Life have paid a number of claims for people, from the simple specialist costs to full gender affirming surgery, done overseas.

The surprise I have comes from most situations I've seen, insurers typically go, the public system doesn't do it, and we won't either.

What about the kids?

For those with kids or looking to have kids:

• As babies are added to existing Partners Life policies without required health disclosures, they will gain coverage that does not have additional exclusions.
• For those that have concerns but symptoms have not yet emerged, taking cover for those kids is also possible.
• While this may not help adults now, in time this will support our kids and grandkids that need this surgery.

Another avenue that is presently still a long way off; is through workplace group medical schemes:

• Where cover is offered with pre-existing conditions accepted and with terms covering gender affirmation treatments.
• This is likely to have some caveats or duration of coverage requirements, given the expense that comes with the surgery.

Time will tell what this looks like; at the same time, the changes that have been made are a great start in the right direction for part of our community that already has plenty to deal with.

We are happy to assist and explain any questions and what options are available. We work on commission, so we're not going to bill you for having a chat either.