Canadian benefit plans fall short on 2SLGBTQI inclusion: experts

It’s June and Pride Month is underway. But while Canadian group benefit plans have come a long way on 2SLGBTQI inclusion, some benefits experts believe there’s still ways to go for any drastic improvement in inclusive benefits.

“In the beginning, it was about making sure the community was eligible for benefits and that was it,” said Celine Morellon, senior principal of compensation, talent and culture at Normandin Beaudry. “It's still new for some of our clients but it's bigger than that now. And the conversations that we’re having is making sure that they feel seen and included and to ensure that you don't exclude them.”

From a plan provision standpoint, Francis Boulianne, principal of health and benefits at Normandin Beaudry noted that gender affirming care has gained the most visibility over the past three to five years but underscored that while adding coverage is the easy part, the harder work is communicating it and embedding it within a broader strategy.

"It's not like a one and done kind of thing. It should be bigger, it should be more like broader holistic kind of approach,” said Boulianne, adding even so, adoption across the market remains low.

Coverage carries unique complexity

According to Boulianne, coverage carries unique complexity in Canada's public-private landscape. While provincial plans like OHIP in Ontario or RAMQ in Quebec cover some procedures, he acknowledged the level varies by jurisdiction. Additionally, employers operating across multiple provinces face a patchwork of public coverage.

"Some procedures might not be fully covered or might not be covered at all by the provincial plan. So, the private can complement that when it comes to either masculinization or feminization procedures," Boulianne said.

Morellon also pushed back on framing gender affirming care in isolation.

"It's linked to fertility and family building benefits. It's linked to mental health support. It's linked to medication coverage. So it's a wider subject," she said.

According to Boulianne, the dynamics driving interest in family building benefits mirror the gender affirming care conversation. He noted how employees in Ontario, Quebec and BC can access some fertility coverage through the public system, but the picture is less clear in other provinces.

Whereas private plans function as a levelling mechanism, public coverage is also often limited to a single cycle, and fertility journeys can be long. He believes a secondary source of coverage matters in those situations.

Inclusive coverage needs to meet various family structures

Awareness has played a role too as Boulianne noted that fertility treatment has become a fixture on the conference circuit across the country over the past couple of years. The core challenge, he said, is building something flexible enough to meet different family structures.

Morellon agrees.

"If you think or rethink or redesign your benefits plans just around the heterosexual couples fertility journey, you're going to miss something," she said. "You need to make sure that you don't exclude same sex couples, single parents by choice, trans employees, employees using donors... You need to make sure that it's accessible for everybody without them having to say they’re a part of the community."

Morellon believes self-identification is a persistent tension as she noted that a large share of the 2SLGBTQI community doesn’t want to disclose their identity in the workplace. Designing benefits that require employees to declare membership in a specific group to access coverage creates a barrier that undermines the intent.

Nadim Kara, executive vice-president, head of people and culture at GreenShield, sees the same fragmentation from the plan sponsor side. He pointed to a stat that underscores the stakes: while roughly one-third of the general Canadian population would leave an employer for better benefits, that figure climbs to roughly 60 per cent among the Pride community.

"Sometimes just to keep it really simple, you exclude a portion of the labour market at your own cost and your own peril, because suddenly you've increased your labour costs," said Kara, noting it’s often because of the lack of an inclusive space. “To me, it's an absolute business imperative that employers wrestle with this and figure it out.”

Inclusive design begins with data

Kara said the case for inclusive design starts with data. The 2SLGBTQI community faces higher rates of mental health challenges, driven in part by systemic barriers, stigma and gaps in access to appropriate care. He underscored that when benefits aren’t designed with that population in mind, employees are more likely to delay care, disengage or seek support outside employer-sponsored programs.

That creates a contradiction for plan sponsors who have invested in coverage for their entire workforce but left a gap for a population that statistically needs it most. Kara believes it to be a workplace issue just as much as a health issue, noting the lived experiences of 2SLGBTQI employees affect productivity, retention and overall employee experience.

Additionally, even well-intentioned plan sponsors can create barriers by accident when services are fragmented and difficult to navigate. Kara said he has seen a genuine shift in mental health coverage, with plan sponsors expanding provider networks and introducing virtual care options to close the gap.

“Simply offering mental health care coverage, it's not sufficient,” he said. “It actually matters to be able to match the employee with the right provider because that drives engagement and outcome.”

Trust with Pride community is the bottom line: Kara

According to Kara, deprioritizing inclusive coverage erodes trust between employer and employee and it’s trust, in Kara’s view, that is the foundation of performance. Canada's progress on issues like gay marriage is recent in the grand scheme of history, and the 2SLGBTQI community remains sensitive to signals that an employer does not see them. He believes that erosion carries direct cost consequence.

"This often translates into lower engagement, higher absenteeism, increased turnover. Employees who do not feel reflected in their benefits are also less likely to fully utilize them, which is a genuine risk,” said Kara, adding that diverse and inclusive organizations consistently outperform their peers, and plan sponsors who want to realize the potential of a diverse workforce need benefits that are relevant to all employees within it.

Cost concerns shouldn’t be a barrier

Cost continues to be in every benefits conversation, and 2SLGBTQI inclusion is no exception. Boulianne acknowledged it’s a consistent challenge he encounters regularly with clients.

"We want to detach the aspect of cost with DEI," he said. "Having a plan that is more inclusive does not mean having a plan that is more expensive."

He pointed to levers plan sponsors already have at their disposal, like redeploying savings from plan optimization, improving how benefits are communicated, and engaging employees in existing coverage. He underscored none of those carry a price tag. Even when changes do involve adding something to the plan, savings from optimizing other areas can be reinvested. He described it as investing in the plan strategically rather than adding provisions without a clear rationale.

Meanwhile, Morellon framed the cost question differently, arguing that inclusive design reduces downstream expenses.

"When you make sure that your organization are built on safety and psychological safety, of course it's going to cost less," she said.

Finally, the political climate south of the border has notably added a new variable, particularly as rollbacks on DEI and transgender-inclusive workplace policies in the US have raised questions about whether similar sentiment will migrate north.

Kara, who has practiced HR in both countries, said the regulatory and cultural contexts are distinct, but acknowledged that global trends can influence conversations. His message to Canadian benefit leaders considering a retreat is blunt: restricting inclusive benefits is "contrary to rational business behavior," he said.

“With what we're facing right now in the world, we need to have a strong, productive, highly engaged workforce that is driving productivity and driving outputs and impact. Inclusive benefits is an underpinning infrastructure to that conversation,” said Kara.