What costs are covered by private health insurance for sex reassignment surgery?
Sex or gender reassignment surgery (SRS or GRS) involves a variety of surgical techniques to change the bodies of people who have gender dysphoria. Both male-to-female and female-to-male SRS is available, and the process involves everything from psychiatric evaluations and hormonal therapy to surgical procedures.
The good news is that if you need to undergo SRS, some private health funds will cover part of the costs associated with the procedure. Let’s take a closer look at what cover is available and how it can benefit you.
Is gender reassignment covered by private health cover?
Although the cost of SRS varies substantially depending on the procedures involved, the process can cost as much as $30,000. This includes surgery fees, specialist’s costs, hospital accommodation, anaesthetist fees and multiple consultations after the surgery.
Medicare provides cover for many of the major surgeries needed for SRS. However, there is quite often a gap between the Medicare benefit paid and the amount your surgeon will charge, sometimes to the tune of several thousands of dollars.
The good news is that some private health insurance policies will provide cover for SRS. In short, you should be able to find a private hospital cover policy that includes any SRS procedure that is also covered by Medicare. But there will typically be a waiting period before you can claim for these services, often for a length of 12 months.
It’s also worth pointing out that some of the procedures required to complete SRS, such as breast enhancement, facial surgery and hormone therapy, are not covered by either Medicare or private health insurance. With this in mind, even if you have a high level of private hospital cover in place you may still have to meet extensive out-of-pocket costs.
What is reconstructive surgery?
Reconstructive plastic surgery is an operation that is usually regarded as medically necessary, such as following an accident or to repair some sort of defect. According to the Australian Society of Plastic Surgeons, reconstructive surgery is "an operation, treatment or procedure performed on an abnormal structure, deformity or tissue of the body arising as a consequence of congenital defects, developmental or acquired abnormalities, trauma, disease, tumour, including surgery or other treatments for such conditions or defects".
As a result, most reconstructive surgery procedures can be covered by private health insurance. These include:
- Operations for traumatic injuries
- Surgery on congenital abnormalities, such as repairing cleft palates
- Operations following severe burns, for example, skin grafts
- Surgery following the removal of cancers or tumours
Of course, this also includes gender reassignment surgery, which means cover is available for some of the procedures associated with SRS.
How is this different to cosmetic surgery?
Reconstructive surgery is different to cosmetic surgery, which is usually not medically necessary. The Society of Plastic Surgeons explains that "cosmetic plastic surgery is an operation, treatment or procedure undertaken to improve appearance where no prior injury from trauma, disease, congenital disorder, congenital or acquired deformity exists".
This includes procedures such as:
- Nose jobs
- Breast implants
- Face lifts
- Botox injections
Cosmetic surgery is not covered by Medicare and therefore is not covered by private health insurance.
Services people can use to find help
There are several national organisations offering support, services and counselling to help transgender people around Australia. These include:
With an aim to provide for Australia’s sex- and gender-diverse community, A Gender Agenda provides advocacy, training and community development.
Facebook: Trans Health Australia
There are also several state- and territory-based support and service organisations, so keep an eye out for one in your area.
Updating your documents
After undergoing SRS you will need to update your information with government departments. Following the adoption of the Australian Government Guidelines on the Recognition of Sex and Gender in July 2013, you can correct your sex marker with any Australian government department or agency by providing one of the following:
- A statement from a registered medical practitioner or a registered psychologist (general registration)
- A valid Australian government travel document, for example, a passport, which specifies your preferred gender
- A state or territory birth certificate, or recognised details of a certificate showing your preferred gender
If you wish to change your name, you can do so by completing the relevant forms from the Births, Deaths and Marriages Registry in your state or territory.
You can also correct your sex on your Australian birth certificate. To do this you must complete the appropriate forms from your local Births, Deaths and Marriages Registry in your state or territory. Once this has been done, you can then apply for a passport showing your correct sex.