Transgender

Hi everyone, I have Matt Rann back with me, fresh from his holiday in Madeira. I am a tad jealous, but I imagine many of you like me have had absolutely glorious weather this weekend, so I’m not feeling too bitter.

Matt is joining me to chat about accessing insurance when someone is transgender. As with many things the insurance world has made clear growth in how it underwrites insurance applicaions for people that are transgender. It’s not yet perfect, but it’s much better than it was and we talk through how things have changed over the years.

The key takeaways:

  1. There are approximately 600,000 people that are transgender or non-binary within the UK.
  2. Transgender is not a mental health condition, but you might end up having to answer questions as if it is, in an insurance application form.
  3. A case study detailing life insurance and income protection for a transgender man.

Next time, I have Roy McLoughlin and Jo Elphick from Legal & General joining me. We are going to be chatting about group insurance, income protection and some research that shows the differences in how men and women approach these areas.

Remember, if you are listening to this as part of your work, you can claim a CPD certificate on our website, thanks to our sponsors Octo Members.

If you want to know more about how to arrange protection insurance, take a look at my Protection Insurance in Practice course here.

Kathryn:       Hi everyone, this is episode three of season four and today I have Matt Rann back with me.  Hi Matt.

Matt:            Hi Kathryn.  Lovely to be back.  As I said earlier, it seems a long time since we had a chat, so it’s lovely to talk to you again.

Kathryn:       It is.  It has been a long time, two months actually.  So yeah, we’re going to have a good natter, aren’t we?  So, today we’re going to be talking about accessing insurance for people that are transgender and this is the Practical Protection Podcast.  So before we really sort of like deep dive into things, Matt, you have just come back off holiday.  I’m sure that there’s going to be a lot of people who are very, very jealous listening to this, that you’ve come back off holiday.  But we do have a little bit of a reprieve in the fact that we’ve just had the most gorgeous weather over the weekend in the UK.  So it was almost like I was tempted to put like pool sounds on in the background and the sound of children jumping in with lilos and things and just close my eyes.  How was it?  Did you have a good time?

Matt:            We had a lovely time, thank you very much indeed.  A slight hiccup to start, when the airport that we were flying to was closed down because of high winds.  Difficult place to land apparently, even for the professionals.  Those of you out there who put those two together, may know where I have been, because it’s apparently quite famous for things like that.  However, so seven days was down to six but had lovely weather,  very stable, but of course coming back to the UK, it’s hotter here than it was on a small island in the North Atlantic.  So it’s kind of great to be back.  But it was also an eye opener.  First time we’ve been away since all the Covid guidelines came in and I have to say, we were absolutely delighted.  We whizzed through Funchal Air – now I’ve gone and told you now, haven’t I?  Funchal, Madeira.

Kathryn:       I was going to say, I think it’s more famous for the cake.  I was going to say, I wasn’t going to be going for the high winds, I was thinking ‘cake’.  As soon as I hear Madeira, cake.

Matt:            Most people think ‘cake’ and I was thinking port and sherry.

Kathryn:       Perfect combination, I’ll bring the cake, you bring the –

Matt:            Exactly.  Very, very slick through Funchal Airport and also very slick through Manchester Airport on the way back.  There were no hold ups.  Tremendous.  So a good time was had by all.  We’re just waiting for our PCR tests now, hopefully to come back negative, that’s the one that you have to take on day two, on arrival from a green country, certainly.  And now amber as well, I think.  But yeah, it was very good and very relaxed and looking forward to our chat to say the least.

Kathryn:       Absolutely, well I’m really glad that you’ve had –

Matt:            Thank you for asking.

Kathryn:       No, no, I’m glad you’ve had a good holiday, it’s just I’m kind of living holidays through other people at the moment because I don’t particularly enjoy airports at the best of times or airplanes so the thought of doing all of this kind of Covid stuff, it just wouldn’t be a holiday for me.  I think I would be traumatised from the airport alone and just not enjoy the holiday, so I’m waiting.  I’m happily waiting.  Waiting and watching to just – until things get a little bit more settled.  And then eventually, I’ll probably just end up getting a camper van and we’ll just go that way.  That’ll probably be the best way to do it.

Matt:            That’s not such a bad thing, especially with three little ones I’m telling you.

Kathryn:       I know and obviously the puppy as well, he could come as well.

Matt:            Of course you’ve got a dog!  How’s that gone?

Kathryn:       He’s doing so, so well.  We’ve had him just over four weeks now but it’s like that thing of just feeling like he’s been with us forever.  But he’s incredibly gorgeous.  He’s a little cockerpoo.  So, anybody who knows the cockerpoo breeds, they are like little shadows, so he is just constantly attached to me.  He’s quite happy with other people, but if he knows I’m around and then he can’t get to me, like at some point I may get a whimpering at the door.  Because he knows that he can’t get to me, but it’s very much that thing that if you go the bathroom, you open the door, he’s right there.  He’s just like, “Hi!  I know you said you’re going to be one minute and I know you’ve spoken to me the entire time you’ve been in there, but still, there was a door between us.  I’m not happy.”  But okay, let’s get on to the main bits of things today.

Matt:            Sure.

Kathryn:       We’re not long since having Pride Month, so I think it’s really important, we’ve both said this, it’s really important to chat through things, because I think obviously in the past, the insurance world hasn’t necessarily been always the most accommodating or sort of like having the best processes in place in terms of supporting people that are transgender.  And so it just felt like it was a good time to put a podcast out.  So, just having a look at a few different things in the background because I think as well – as well as sort of like how to maybe approach these conversations as an insurer, you’ve also got advisors and what to do.  Because you can get a bit paranoid as advisors, because it’s a case of, “Well, I can’t really assume that somebody is male or female, even though you may think you know that they’re male and female but I don’t –”  And obviously, it’s a case of well, you can’t ever make that assumption and then you kind of think, “Well, where do I ask it?  Do I ask everybody, ‘Do you identify male or female and kind of what pronouns you use?’”  So I try and give a little bit of a background on some of the things to be aware of.

So first things first.  Stonewall is an organisation within the UK and they do say that there’s roughly 600,000 people that are transgender or non-binary living within the UK.  So we’re not talking a small amount of people here, we’re talking about a lot of people that, you know, it’s quite easy to think that obviously insurers and advisors are going to come across somebody in this situation at some point.  So I think one of the first things that I find really helpful is always trying to maybe understand the terminology at first.  Just to – so I feel comfortable that I’m hopefully not going to say anything wrong, or if I do say something that’s not completely sort of right, that I can at least sort of say, “Obviously, I’m really sorry, that’s my misunderstanding,” and try and move forward that way.

Matt:            I think that’s a very important point, Kathryn.  I think asking those types of questions shows that you know your clients and will give them confidence in your ability to talk sensibly.  I think that’s very important to give the client confidence.

Kathryn:       Absolutely and I think, you know, again with advisors – sometimes advisors get a little bit scared, because it’s that thing of, “What happens if I get it wrong?  What happens if I’ve assumed that they’re female?”  If somebody has said that they’re married and I’m speaking to a man and then I’ve assumed that the partner is a woman.  Or maybe, and this goes a little bit away from the transgender side of things –

Matt:            No, no, no, it’s very important.

Kathryn:       As people understanding as well, they may say automatically, there may be somebody who has transitioned to female, so it can be a husband and wife but maybe from their understanding of the insurance world, they may think, “Well actually, the wife was born male – it was assigned male identity at birth, so they need to see male on the forms instead of female.”  It’s a very, very confusing situation for everyone.  I think it’s fair to say that the advisor’s going to be confused and the person who’s coming to you is confused because they probably don’t know exactly how these forms are going to need to be filled out.  So I think hopefully we’re going to sort of like debunk some of those things today.

Matt:            Yeah, great.

Kathryn:       So in terms of transgender, so that is the term that is used for someone that does not identify with their assigned gender at birth and I think sometimes people get unsure as to whether or not to use the term ‘transgender’ or ‘transsexual’.  So, transsexual is a term that was more used back in the day or sort of a bit of an older term.  A lot of people prefer to use the word ‘transgender’ now, instead of ‘transsexual’.  That’s not everybody.  I’m just saying that in general, people tend to prefer the word transgender because transsexual is more seen as if it was like a medical thing that was happening rather than it just being that this is someone and this is who they are.  Pronouns are something that I think a lot of people get quite confused by, especially on social media, you see quite a thing of people putting on that they may be ‘she’ or ‘she/her’, or ‘he/him’, or ‘they/them’.  And there’s quite a few other ones as well.

And I think it’s fair to say that most people don’t expect everybody to understand every single pronoun or version of sort of like the classification of a transgender or non-binary way that somebody would classify themselves because there are many, many versions.  One of the things that I have done in the past and just in case anybody would find this interesting, is that I found a website called LGBT Hero and essentially, I went on Google and I did, you know, one of those standard kind of searches saying like, ‘What do pronouns mean?’ or something like that. ‘How can I support people when they are using pronouns?’  And this website came up and I found it really useful because it gave really short, succinct descriptions.  It also gives you a list of all the different classifications that people might put to themselves.  And I think that’s really useful because there was far more on there than – I’ve heard more than what I’ve just said here, but there was more on there written down for me to read than I had actually ever heard of.  And there’s even some on there as well, I have to say, pronouns-wise, I’m not completely sure how I would pronounce some of them, because some of them I think – it’s like, one of them is the word ‘xe’ and – with an extra sort of like version to it as well.  And I’m not sure how to pronounce that, so it may well be that somebody says something to you about their gender and you’re not completely sure of how they want to be spoken to.  So it can just be quite a good idea to just say to somebody, be honest and just say, “Thank you, that’s incredibly helpful for me to know and I will use these pronouns for you.  Do you mind me just asking, just to make sure I’m going to be pronouncing it correctly?”

And if you’re really not sure, sometimes I think if you’ve written something down or if you’ve seen it in writing, it can make it sometimes stick in your head a bit more.  So you can always, I would say, just ask them to say, “So how would I write that pronoun down, if for some reason we are making notes and I can make sure that I write it down the right way for you.”  And I think the majority of people are quite understanding about the fact that if they are coming with a pronoun or a gender that you would maybe not be familiar with, that it’s something that they’ve probably experienced in quite a lot of places.  It’s probably not a shock to them that you don’t necessarily have that in the forefront of your mind but it’s your approach to how you accommodate and speak to that person afterwards that will be, in a sense, what gives them the feeling that you’re really supporting them.

Matt:            Yep, 100% agree with that Kathryn, very, very important indeed, I believe.

Kathryn:       Yeah.  So as I was saying, you know, when it comes to things like the gender, the assumption I say, because one of the things I do with the training with my advisors is, you know, I’ll –  when I do the role play training with them, which obviously as I’m sure everybody can imagine, everybody loves the role play training that I do. And they’re doing – there’s times where I’ll be saying to them, “Right, there’s this person”, and they’ll know, so I start it off by saying, “Right, you’ve got this man and he is married.”  So my advisors are trained to go, “Right,” so straight away they’re figuring out –“Okay –” so they’re speaking to me, they know automatically they’re a man and married, but they’re sort of like speaking to me, “Oh, and just to check you’re married”.  But they are trained to then be very careful with the wording to then say, “And does your partner have cover?”  So that we’re not going into, “Oh, so this is a man, he’s married, right, there’s a wife.”  You know, because I think there is still probably that stereotypical assumption that people do kind of in their mind have man, woman, woman –

Matt:            Absolutely.

Kathryn:       And, you know, obviously that may be what a lot of people have come across, but it’s just a little thing of just being really conscious in your own mind to say ‘partner’, rather than assigning a gender to the other person.  And then that’s really important to people who are transgender, but also people who are in relationships where obviously you maybe have two men in a marriage or two women in a marriage, just to make sure that you can then, as you’re chatting, you know, they will then refer to the partner’s name and so you can then start to really figure out and they’ll maybe use, as I say, the pronouns and things, and sort of like say – sort of like, “Oh well, she’s doing this at the moment, so unfortunately she can’t be on the phone with us as we’re speaking,” so straight away you know, “Okay right, so it is a gender identification of female.”  And it does feel a little bit unusual at first, I have to say, but as with anything, it’s learned experience, so once you’ve done it a few times, it becomes much, much more normal, when you’re saying it that way.  So hopefully that helps some people, a little titbit for people to take away.

Matt:            What’s interesting for me as an underwriter, Kathryn, and it’s valuable to hear that, so thank you, from an underwriter.

Kathryn:       I’m glad to hear.  So I think going back to some of the things that we’ve just been saying as well, I think because obviously, as I said, some people just don’t know what they’re going to expect when they come for insurances and I think that’s the same for a lot of people, if they’ve got any kind of situation where they think it might have an influence on the insurance.  And I do think that for people who are transgender, there is that kind of, you know, for some people, I think there is sort of like a case of, “What am I going to need to do, what gender am I going to need to put on these forms, what are they going to put it down as, is it going to go down a certain way on the form, what kind of terms am I going to be looking at?”

So I think a really good idea is to talk about the fact that things today are far, far better than they used to be.  As with most situations and hopefully most kinds of organisations and sectors, things are better than they were.  I’m not saying they are perfect, but a lot better than they were.  So I think a good starting point would be – because some people are going to have heard probably some horror stories from years gone past, Matt.  But maybe talking about many, many years ago, what would be the case, if somebody had come, many years ago, to the insurance world and said, “Right, I’m here, I’m transgender and I want insurance.”  What kind of questions would have been asked maybe and what kind of terms would have been maybe considered?

Matt:            Okay, well thanks for that difficult question, Kathryn.  Certainly, I’ll probably stay away from transgender just for a minute, but certainly in the height of the HIV scare, that was a very real scare for very obvious reasons, certainly the insurers used to ask very, very personal questions of men in particular.  It did go down to if you were a single man – which again is quite silly, now we think about it and if you were a single man, they would ask questions of a very, very personal nature.  Not only around maybe the different number of partners you’ve had, but what type of sex you actually engaged in.  Which frankly now, in the year 2021 and the way that the world and the insurance industry has moved on, are horrific questions to go around asking people, to be perfectly honest with you.

Kathryn:       It feels strange that, you know –

Matt:            I find it absolutely horrific, looking back on it.  I do –sorry Kathryn, I did interrupt you there.

Kathryn:       No, no –

Matt:            There is a part of me and a very small part of me now which would say, “Well, was it an overreaction?”  It certainly seems like it now, but if you are trying to protect a very large portfolio of business from a risk which was totally unknown really of what the end game would be then I’m afraid the only option would be to say – the only endgame option would be, you don’t touch anybody who’s a single male, as an example.  And therefore the underwriters in a way at that particular time were trying to give cover – at least they were trying to give cover – the approach – so the goal I think should be applauded.  The way that we actually tried to get to that goal is certainly now, and I believe it then, was totally unacceptable.

So life has moved on, I think, certainly the timing – I wasn’t quite sure of the timing when all these things kind of disappeared from the insurance industry, but I think you and I agree it’s at least around 15 years ago, it’s 2005 I think we talked about.  And I’ve not seen anything like that since.  But it’s – overall, underwriters I think, certainly of my age who lived through that type of underwriting process will look back on that as a lesson learned.

Kathryn:       Yeah.  Quite a lot of cringing.

Matt:            Indeed.  Do we hang our heads in shame?  Well possibly, but on the other hand, what else could we have done apart from decline an awful lot of people and just not give them insurance whatsoever which I don’t think is good for anybody, good for the market or anything.  So yeah, I generally believe that we’ve learnt from that.  I mean, legislation has come on board now thick and fast since those times, which only allows justifiable discrimination and that’s one definitely for another day, to discuss what justifiable discrimination actually means.  But certainly we’ve gone a long, long way from that type of intrusive questioning.  So yeah, all I would say is I think lesson learnt on that and thank God as well.  Would you see that in your own cases that you see and conversations that you see, Kathryn?

Kathryn:       Yeah, I mean absolutely.  So I think, as I say, I think Alan joined the industry around 2005 and I joined it in 2010.  And I’m sure I remember Alan saying that it was still in the application forms at least when he’d started.  I have a vague recollection of it being possibly even around the time that I joined but I don’t know if that was more a case of that I was looking at an older case and looking at the application form and going, “What on earth are they asking here?” kind of thing, because I understand what you’re saying because ultimately, insurers are businesses.  They have – they offer risk – they assume there are certain risks, but they have to maintain certain financial capitals.  If there’s suddenly a risk that they don’t have a lot of data on, very similar to Covid, then there is going to be quite a knee-jerk reaction, they’re not going to be really sure what to do and possibly, as you say, the questions that might in a sense go overboard, you know, it doesn’t negate how people would have felt at that time obviously going for insurance.

But it’s sort of like that thing, it’s not justified the way that the approach was done, but it’s – you can kind of understand.  I’m not saying that’s okay, for anybody who’s listening, I’m not saying it’s okay, but you can understand why the insurers were doing such a quick reaction because it was something new that they weren’t massively aware of, they didn’t have that long data.  And at the time, obviously because there was this fear of HIV and obviously there wasn’t the same medications and treatments as there are now.  Obviously HIV was certainly not what it is today.  And I think, you know, there is that fine balance between – I don’t think we should just bash insurers and underwriters and actuaries for the decisions that are made, it is that thing though of the learning experience.

So, obviously as the data has become available and as things are progressing, you know, obviously we’re now at a point where we’re seeing sometimes really incredible terms for people that are living with HIV.  So I think that’s a good example of how things have moved on in some ways, but obviously we’re not saying in the slightest that people who are transgender are men who potentially, you know, have HIV.  But I think it’s important to sort of just say that that’s potentially a situation that somebody might have experienced in the background – sorry, not in the background, some time ago.  But now it’s – it couldn’t be further from that, I don’t think.  There’s some things we’re going to be chatting about again where we’re going to be saying we’re not sure how we can necessarily fix this side of things, as we’re chatting a bit more, but there used to be a thing as well and I know this wasn’t too long ago as well and I think this has started to dwindle off since the gender pricing that became standardised.

So, for anybody who’s quite new to the industry, I can’t remember the exact year, I’m thinking 2016 but maybe I’m wrong, there was a specific legislation that came out that basically said that you couldn’t price differently for men or women in insurance.  Everybody had to have the same pricing.

Matt:            Time flies Kathryn, time flies.  2012.

Kathryn:       2012 oh wow, yes absolutely.  Something happened in 2016, I don’t know what, but something happened.

Matt:            No worries at all.  It’s just – isn’t it amazing though, how we remember these things and think it was like yesterday, when in fact it was years and years ago.

Kathryn:       It’s almost a decade ago. That’s absolutely – oh wow.

Matt:            I know, frightening isn’t it?  Either way –

Kathryn:       That’s a huge amount.  That means that actually – so yeah, that means I’ve just had my 10-year anniversary in the industry a couple of weeks ago.

Matt:            What can I say?  Congratulations!

Kathryn:       Thank you.

Matt:            You look well on it too, it has to be said.  No great big bags under the eyes, or anything else or, you know –,

Kathryn:       It’s the lighting on the Zoom, it’s photoshop filter.  No, it’s alright, I’m not using a filter  I need to though.  So yes – so basically, they used to do it where for say, life insurance, men used to be a charged a higher amount because the likelihood of a man dying at a younger age than a woman was higher and then in kind of reverse, women used to be charged higher for income protection, because the likelihood of a woman being unable to work due to health was higher than a man.  So they all kind of became equalised and nobody was allowed to do anything like that.  And I think probably since – so actually it will be – it’s still a while then since that happened then in 2012 but probably in the last few years or so, they’ve stopped asking for certain things.

So they used to ask quite a lot for gender reassignment certificates I believe with quite a few insurers to be able to actually – because I think this is probably one of the main questions, is like, “Right if I’m transgender and I was assigned a male gender at birth but I’m now a woman, what do I put down on these forms?  Do I put down male or female?”  Now what it used to be is that unless you have the gender reassignment certificate, you had to go down as the gender that you were assigned with at birth, but that’s no longer the case now Matt, is it?

Matt:            No, no, no.  In terms of a proposal form, you would put down the gender that you are – that’s legally attributed to you.  So if you’ve been transitioned to a woman, you put down a woman, you put female.  It’s really as simple as that.  So, no issues there, I don’t think.  Important to raise mind you, because I think it’s important people who don’t necessarily come across this type of thing, particularly with insurance, then I think it’s certainly well worth knowing.

Kathryn:       Absolutely.  And to know as well just that sometimes these things used to be asked for and those certificates may not be asked for now.  So just, you know, it may not be that we see people who are transgender regularly when we work.  So it’s that thing if sort of like it’s been a while, just make sure that you know, as with anything, make sure you know sort of like the latest rules and requirements and things like that.  But generally, as we’re chatting more, it would be good to obviously be able to get across that really actually being transgender is going to have very, very little impact upon the insurances, if at all.

But we’ll just sort of like chat a little bit then, I mentioned about how, you know, obviously potentially putting on these forms men and women, if you’re male or female.  Now I imagine that presents quite a difficulty for quite a few people now, obviously especially the people in the non-binary space, because we don’t have a non-binary option.  And I’ve been sort of like thinking and been trying to figure out why we don’t have a non-binary option.  Now I do know that when – well, I say I do know, I believe from my understanding that to make changes to the forms, for insurers to make changes to their insurance application forms, isn’t the quickest of things and that it maybe takes a while. Because it’s not just changing the form, it’s changing all the systems in terms of the recording and the databases and the different areas and obviously where they sort of like promote out if they don’t then also have a third section for offering a non-binary option then that in itself could, you know, there’s so many different technicalities that would need to happen.  It would really need to be I think, quite an industry effort to be able to do that.

Matt:            Totally agree with you on that, it has to be across the industry to do that, led by somebody like the ABI, or similar.

Kathryn:       Absolutely

Matt:            And you’re absolutely right, having lived in that insurer world, it is a big job even – particularly these days with the way that systems are tied up with underwriting systems.  So back-office systems with underwriting systems, it is quite a big job and with the push for new business, I’m afraid that box, if you like, is likely to come down the tree, in terms of pecking order.

Kathryn:       Yeah and priority is probably not –

Matt:            Absolutely.  So, you’re absolutely right, it’s a big change and you’d think it was very, very simple, but it’s not.

Kathryn:       I think another thing that stands out for me – so that’s one scenario obviously as to why, is the time and the resources that would need to be done, it’s not just a quick –

Matt:            And the priority it happens in.

Kathryn:       Change the paper form, it is huge technological changes, it’s not just within the insurers, it’s within platforms that kind of have the centralised application form, the price comparison site type situation, it’s getting all of those areas as well.  And then there’ll be some advisor firms who possibly have options where the forms are done on their website.  There’s so many areas that it would need to be done through.  It’s not a small task.  Not saying that it’s not important, it’s incredibly important, but it’s not a small activity for insurers to be doing.

But I think the other thing for me that stands out is how it could potentially influence things, especially within, I imagine, like the critical illness and income protection space, in terms of underwriting.  Because – and obviously decisions that are made – because obviously in some, you know, in some situations, so say like if somebody is female and they are going for critical illness cover and they happen to have maybe had – their Mum had had breast cancer at a young age, that could potentially influence the decision on the policy – depending upon the insurer, depending upon the really specific data.  I’m not saying this is going to happen to everybody, but it could well be that there could be a breast cancer exclusion on the critical illness contract for that person because of the family history.  Now, I don’t believe that you would necessarily get that the same, if that person was a male and had a mother who had had cancer.  I don’t think there would, there wouldn’t be a breast cancer exclusion, I don’t believe.  You could correct me Matt, right if I’m wrong, but I don’t believe there would be.

So then it’s that thing of, “Well, hang on, are we actually being – in some ways, are we actually being fair at all?”  Because that would mean that someone who was female and transitioned to male would actually have better terms for cover than someone who has remained female with the same family medical history.  And obviously there is a difference in the person who has transitioned to male as he probably obviously has taken testosterone and very different but then you have the other argument of, “Well if someone was male and transitioned to female, they have possibly taken quite a lot of female hormones, so would that actually in the end kind of increase the risk based upon the family medical history as well?”  I know that’s a lot of ifs and everything that I’ve just said all in one go Matt and I hope that everyone that’s listening has been able to follow it, but it does kind of feel like it doesn’t necessarily marry up at the moment.

Matt:            I think there are two very interesting points there.  I think that the European Gender Discrimination Act that came in in 2012, it never ultimately – well let me put it this way – and modern countries within the European Union possibly didn’t think through the complications of situations like we’ve just described.  It was supposedly a very simple, “Well men should pay the same amount of premiums of women, end of.”  But when you’ve got all of these side issues, very important but nevertheless side issues, then it becomes very, very complicated indeed.  And it’s a classic case for me of unintended consequences.  Absolute classic case of that.  So yes, you’re going to get situations like that where it is pretty difficult.  I mean, it’s an interesting one.  I mean, if you’re looking at females who transition to males and I suppose as you have just said, high doses of testosterone is a standard form of cross-sex hormone treatment.  And the side effects, no surprise including gain in body mass, increases in blood pressure and cholesterol and other side effects can also include osteoporosis, increased emotional lability, elevated liver enzymes and also, importantly, I think we may have touched on this, maybe from the outside though, and the development of hormone-related tumours.  Although the latter is pretty rare at the moment, so it’s a bit of a watching brief in terms of the insurance industry.

Now, the other way round, so male to female, as you again have said, treatment is usually with high doses of oestrogen, there’s an increase in visceral fat, and despite the fact of the levels of HDL have increased, the overall cardiovascular profile.  So if you think of men tend to die of heart attacks or sorry, cardiovascular disease more than women, similarly at certain ages, the overall cardiovascular risks profile of male to female transsexuals reduces implementation with the implementation of cross-sex hormone treatment.  So, I don’t think anything I’ve just said there would have been a surprise when you’re using male hormones or female hormones.  Those are the types of things you would expect in a male or a female.  But nevertheless, I think one of the important points you’ve just said that – and highlighted but I’ll also reinforce it, that if you are transgender and the key areas of underwriting that will be looked at are not that you are transgender whatsoever and if you’re transgender and free of any medical disorder, then you will get standard rates.  I can’t say everybody, because I don’t have sight of the whole of the UK industry.  But you will generally get standard rates for life, CIC, sorry, critical illness and also income protection.

Now, the underwriters will certainly look at psychological issues and they will obviously look at depression, anxiety, a history of, or that continuing after a transgender operation.  And obviously they will also look at associated lifestyle issues which sometimes go along with mental health issues such as alcohol abuse and drug abuse as well.  In terms of an operation, if you are looking to have the operation, then yes, life cover will be generally postponed in line with any operation of a similar risk, okay?  So it’s not a special transitional gender reassignment loading or risk or postponement, it’s the same with anybody else who’s having an operation of a similar medical risk.  A surgical risk.  Of which there are, for some operations, you have to face that.  In terms – and what underwriters will generally want there is just a sign-off from the treating surgeon that everything has gone well and there are no complications and you go on your merry way with standard rates, normal terms.  Again, the psychological issues are treated the same as any other person who has anxiety, depression or suicidal – God forbid, suicidal thoughts or anything like that.  They will be treated exactly the same as anybody else.  So the fact that you’re transgender does not make a difference in the context of risk.

Kathryn:       Yep.  I think it’s quite interesting that one, I’m really glad you’ve brought that up, because I think one of the big things that can sometimes be seen as sort of like a little bit – nothing that you’ve said but, you know, just generally something that can be seen as offensive to people that are transgender is that somebody saying that it’s something to do with mental health.  Because, you know, it isn’t mental health and I think – but there is a really difficult distinction when you’re doing these forms, especially as an advisor or for anybody who is involved.  Because a little while ago, we were helping somebody to get insurance and they were somebody who was transgender that transitioned, they’d had the surgery and everything.  And we were going through the application form and obviously being transgender isn’t a mental health condition, however, this person was really insistent that we put it down as a mental health condition.  And we were trying to be – obviously we were being really supportive and just saying, “Look, it isn’t classed as a mental health condition in the insurance world, you know, yes we will put down that you’ve had an operation, because timing-wise it was a case of, ‘Yes, we’re going to put down that you’ve had an operation, but it doesn’t need to go down as a mental health route.’”  But they were very much of the opinion that for themselves, that it was a mental health condition for themselves and that was kind of part of the whole thing for them.  Which was quite unusual, because obviously I think when you do do training in this, you are trained not to think of it as a mental health condition.  So for somebody to say it really is, it felt quite strange actually to complete the form in that way.  But I think it’s really important just that people are, you know, especially advisors, they’re aware of that, they may face that.

But on the other side of that, the difficulty is as well, is that a lot of people who will have been through surgery, especially if it’s been performed in the UK, will have seen a psychiatrist.  So, it will go into the mental health question set, there’s no way of us avoiding that, because it will be in the – and obviously we’ve always got our list of questions – “Have you ever had – have you in the last five years, have you in the last three years, have you in the last three months?” kind of situation, when it comes to these questions.  So in the ‘have you ever had’, the psychiatrist question is probably going to be there.  So you’re going to straight away answer that, at which point, you’re going to need to say why.  At which point you’re going to have put down transgender as the reason why and probably go through all the usual mental health question set.  And I think as an advisor, what we would need to – what I would suggest people do if they are facing that situation, is something that I do a number of times with different things that I see that come up in these question sets, is I apologise on behalf of our industry and just say, “Look, I’m really sorry, but this is the way that the insurers’ application forms are set up.”

So as soon as we know there’s a psychiatrist involved, there’s an automatic assumption there’s a mental health condition and so we need to ask all those questions.  And as soon as we say there’s a mental health condition, I have to ask you all of these.  It doesn’t matter in a sense, even if it was just mild anxiety that you’ve had, I’m going to need to ask all of these quite, potentially intrusive, mental health questions, to be able to get the insurances for you.  I don’t really think that there’s a way for us to get around that.

Matt:            I think first of all, you were right that if the proposal form question does actually ask about, “Have you ever seen a psychiatrist?” then I would certainly encourage people to say ‘yes’, but give an explanation as to why.  “This was part of a gender reassignment process, end of.”  Now, I think you will find – you should find with good underwriters that they would actually see that as a positive, not a negative, as part of – that the individual concerned is actually looking after their mental health and freely discussing how they feel.  I will just reiterate the fact that it would be seen as a positive to an underwriter.  A positive answer to a question doesn’t count against the individual whatsoever – the client whatsoever.  It is an underwriter trying to understand the risk, if any, that they are actually facing.  So I think the person who looks after their mental health – so it’s a very, very good sign.  And I would certainly endorse, 100%, that the underwriting fraternity do not think that transgender is a mental health issue.

Kathryn:       Yeah.

Matt:            It is a fact, sadly, that a number of people who do enter the kind of gender dysphoria and then decide to transition over, do have anxiety and do suffer – and that may move into depression and so on and so forth and that’s a very sad thing.  But also perhaps to be expected from such a huge change in their life –

Kathryn:       Absolutely.

Matt:            And, as I say, underwriters are aware of that and the actual condition of anxiety or depression or whatever, is treated exactly the same as anybody else.  Just in inverted commas, that it is a transgender, it does not make a difference.  And as I say, positive, “I’ve seen a psychiatrist because of the gender transition,” is a positive, it’s certainly not a negative.

Kathryn:       Absolutely.  Thank you.  Well I’ve got a case study to just quickly go through.  We’re coming towards the end of the episode now.  So it is an example of somebody who is transgender that needed some insurance, so we spoke to a couple and it was a male and female life.  The male had been a female many years ago and had transitioned to being male and they were in their mid-thirties to early forties.  So what they needed was some cover for their mortgage so we did them some joint decreasing life insurance of around £312,000 over 22 years and the premium was just under £35 a month.  And what’s to be clear on that as well, is that that was what’s classed as ‘normal terms.’  So normal terms is that the premiums haven’t been affected at all by the disclosure.  So that would include obviously having had the surgery and seeing a psychiatrist as well.  And also, for the male life, you know, he needed some income protection.  So it was about £3,000 per month, we had a 13-week deferred period to age 60 with a full claim length and that was around about £83 per month at a guaranteed premium.

What’s important about that one as well is that there was an exclusion on the income protection, just to be very, very clear and transparent but that was because – well he had had a shoulder injury a couple of years beforehand, I think it was, sort of like some kind of sporting shoulder injury.  And so he ended up with a shoulder exclusion on the policy.  Which – so again, nothing at all to do with being transgender, but as with many people, or I would say a significant majority of people if they’ve had something in terms of a shoulder injury and they’re wanting income protection, most places are going to be seeing an exclusion on there, at least for a certain time period.  It has potential sometimes that you can ask it to be a reviewable exclusion, it depends upon the insurer, depends upon I think, maybe how sunny it is on that day, as to whether they want to do it or not.  But yeah, that’s sometimes –obviously that’s just a good example of what we can see where as I say, you’ve got life insurance, say you’ve got income protection and really, in terms of the actual – as I say, the transgender side of things, it’s been no influence whatsoever upon the cover.

So, we are at the end of the podcast.  It’s been really, really lovely to chat to you again Matt, it’s always great to get your insights.

Matt:            Well thank you, Kathryn.  Thank you for inviting me, as always.  A fascinating topic and I think – I hope that we’ve put some – those clients – those people out there who have transitioned or are thinking about transitioning have built up their knowledge and they feel confident in applying for insurance.  Because they should do.

Kathryn:       Absolutely.

Matt:            We are not the ogres we were perhaps once seen as.  You know, we’ve matured and we look forward to receiving the business.

Kathryn:       Absolutely.  I think you’re completely right.  I think, you know, as long as we say to people as well, just depending upon the situation, you know, sometimes be patient, obviously, the insurance world is doing incredibly well.  Advisors are doing incredibly well.  Lots and lots of departments are in terms of trying to be much more aware, much more understanding.  You know, if somebody isn’t necessarily using your preferred pronouns at first maybe, you know, just obviously make them aware of you prefer to be addressed and obviously, possibly have a bit of patience.  Obviously at the same point, if someone is just being downright rude and ignoring you, then absolutely don’t be happy and tell them that you’re not happy.

But it’s one of those things that we’re all growing, we’re all learning and I think sometimes unless you’ve actually experienced speaking to somebody living in this situation, it can be quite hard.  We can know about these things, but actually living it and experiencing it and knowing how to actually speak to somebody in a situation can sometimes be – can be – it can just be something people aren’t used to and we are creatures of habit, we’re creatures of learning and it’s certainly something that I do as well, really within our industry, really, really hope that people do take the time to just sort of maybe do a little bit more in terms of looking up these different things – these different pronouns, the different types of classifications when it comes to gender and I know some people are possibly quite – I think some people are possibly still quite guarded and are probably still very much, “Well there’s men, there’s female.  I can maybe see non-binary, but I’m not having 20 versions of non-binary.”  And I think it’s important to sort of like say that it’s really not – it doesn’t affect you to be more aware of it but it would really affect the person that you are speaking to.  So it’s just extremely important to just maybe even just give it a once over, just a quick look over things and just make yourself a bit more aware.

I’m going to be back in a couple of weeks’ time with Roy McLaughlin and Joe Elphick from L&G.  We’re going to be discussing group insurances and again some stuff about gender as well.  If you’d like a reminder of the next episode, please drop me a message on social media, or visit the website practical-protection.co.uk and as always, don’t forget that if you’ve listened to this as part of your work, you can pop on over to the website and claim a CPD certificate too thanks to our sponsors OctoMembers.  So thank you very much for your time today, Matt.

Matt:            My pleasure.  Look forward to speaking to you again.

Kathryn:       Look forward to speaking to you, too.  Bye.

Matt:            Bye.

Transgender

Hi everyone, I have Matt Rann back with me, fresh from his holiday in Madeira. I am a tad jealous, but I imagine many of you like me have had absolutely glorious weather this weekend, so I’m not feeling too bitter.

Matt is joining me to chat about accessing insurance when someone is transgender. As with many things the insurance world has made clear growth in how it underwrites insurance applicaions for people that are transgender. It’s not yet perfect, but it’s much better than it was and we talk through how things have changed over the years.

The key takeaways:

  1. There are approximately 600,000 people that are transgender or non-binary within the UK.
  2. Transgender is not a mental health condition, but you might end up having to answer questions as if it is, in an insurance application form.
  3. A case study detailing life insurance and income protection for a transgender man.

Next time, I have Roy McLoughlin and Jo Elphick from Legal & General joining me. We are going to be chatting about group insurance, income protection and some research that shows the differences in how men and women approach these areas.

Remember, if you are listening to this as part of your work, you can claim a CPD certificate on our website, thanks to our sponsors Octo Members.

If you want to know more about how to arrange protection insurance, take a look at my Protection Insurance in Practice course here.

Kathryn:       Hi everyone, this is episode three of season four and today I have Matt Rann back with me.  Hi Matt.

Matt:            Hi Kathryn.  Lovely to be back.  As I said earlier, it seems a long time since we had a chat, so it’s lovely to talk to you again.

Kathryn:       It is.  It has been a long time, two months actually.  So yeah, we’re going to have a good natter, aren’t we?  So, today we’re going to be talking about accessing insurance for people that are transgender and this is the Practical Protection Podcast.  So before we really sort of like deep dive into things, Matt, you have just come back off holiday.  I’m sure that there’s going to be a lot of people who are very, very jealous listening to this, that you’ve come back off holiday.  But we do have a little bit of a reprieve in the fact that we’ve just had the most gorgeous weather over the weekend in the UK.  So it was almost like I was tempted to put like pool sounds on in the background and the sound of children jumping in with lilos and things and just close my eyes.  How was it?  Did you have a good time?

Matt:            We had a lovely time, thank you very much indeed.  A slight hiccup to start, when the airport that we were flying to was closed down because of high winds.  Difficult place to land apparently, even for the professionals.  Those of you out there who put those two together, may know where I have been, because it’s apparently quite famous for things like that.  However, so seven days was down to six but had lovely weather,  very stable, but of course coming back to the UK, it’s hotter here than it was on a small island in the North Atlantic.  So it’s kind of great to be back.  But it was also an eye opener.  First time we’ve been away since all the Covid guidelines came in and I have to say, we were absolutely delighted.  We whizzed through Funchal Air – now I’ve gone and told you now, haven’t I?  Funchal, Madeira.

Kathryn:       I was going to say, I think it’s more famous for the cake.  I was going to say, I wasn’t going to be going for the high winds, I was thinking ‘cake’.  As soon as I hear Madeira, cake.

Matt:            Most people think ‘cake’ and I was thinking port and sherry.

Kathryn:       Perfect combination, I’ll bring the cake, you bring the –

Matt:            Exactly.  Very, very slick through Funchal Airport and also very slick through Manchester Airport on the way back.  There were no hold ups.  Tremendous.  So a good time was had by all.  We’re just waiting for our PCR tests now, hopefully to come back negative, that’s the one that you have to take on day two, on arrival from a green country, certainly.  And now amber as well, I think.  But yeah, it was very good and very relaxed and looking forward to our chat to say the least.

Kathryn:       Absolutely, well I’m really glad that you’ve had –

Matt:            Thank you for asking.

Kathryn:       No, no, I’m glad you’ve had a good holiday, it’s just I’m kind of living holidays through other people at the moment because I don’t particularly enjoy airports at the best of times or airplanes so the thought of doing all of this kind of Covid stuff, it just wouldn’t be a holiday for me.  I think I would be traumatised from the airport alone and just not enjoy the holiday, so I’m waiting.  I’m happily waiting.  Waiting and watching to just – until things get a little bit more settled.  And then eventually, I’ll probably just end up getting a camper van and we’ll just go that way.  That’ll probably be the best way to do it.

Matt:            That’s not such a bad thing, especially with three little ones I’m telling you.

Kathryn:       I know and obviously the puppy as well, he could come as well.

Matt:            Of course you’ve got a dog!  How’s that gone?

Kathryn:       He’s doing so, so well.  We’ve had him just over four weeks now but it’s like that thing of just feeling like he’s been with us forever.  But he’s incredibly gorgeous.  He’s a little cockerpoo.  So, anybody who knows the cockerpoo breeds, they are like little shadows, so he is just constantly attached to me.  He’s quite happy with other people, but if he knows I’m around and then he can’t get to me, like at some point I may get a whimpering at the door.  Because he knows that he can’t get to me, but it’s very much that thing that if you go the bathroom, you open the door, he’s right there.  He’s just like, “Hi!  I know you said you’re going to be one minute and I know you’ve spoken to me the entire time you’ve been in there, but still, there was a door between us.  I’m not happy.”  But okay, let’s get on to the main bits of things today.

Matt:            Sure.

Kathryn:       We’re not long since having Pride Month, so I think it’s really important, we’ve both said this, it’s really important to chat through things, because I think obviously in the past, the insurance world hasn’t necessarily been always the most accommodating or sort of like having the best processes in place in terms of supporting people that are transgender.  And so it just felt like it was a good time to put a podcast out.  So, just having a look at a few different things in the background because I think as well – as well as sort of like how to maybe approach these conversations as an insurer, you’ve also got advisors and what to do.  Because you can get a bit paranoid as advisors, because it’s a case of, “Well, I can’t really assume that somebody is male or female, even though you may think you know that they’re male and female but I don’t –”  And obviously, it’s a case of well, you can’t ever make that assumption and then you kind of think, “Well, where do I ask it?  Do I ask everybody, ‘Do you identify male or female and kind of what pronouns you use?’”  So I try and give a little bit of a background on some of the things to be aware of.

So first things first.  Stonewall is an organisation within the UK and they do say that there’s roughly 600,000 people that are transgender or non-binary living within the UK.  So we’re not talking a small amount of people here, we’re talking about a lot of people that, you know, it’s quite easy to think that obviously insurers and advisors are going to come across somebody in this situation at some point.  So I think one of the first things that I find really helpful is always trying to maybe understand the terminology at first.  Just to – so I feel comfortable that I’m hopefully not going to say anything wrong, or if I do say something that’s not completely sort of right, that I can at least sort of say, “Obviously, I’m really sorry, that’s my misunderstanding,” and try and move forward that way.

Matt:            I think that’s a very important point, Kathryn.  I think asking those types of questions shows that you know your clients and will give them confidence in your ability to talk sensibly.  I think that’s very important to give the client confidence.

Kathryn:       Absolutely and I think, you know, again with advisors – sometimes advisors get a little bit scared, because it’s that thing of, “What happens if I get it wrong?  What happens if I’ve assumed that they’re female?”  If somebody has said that they’re married and I’m speaking to a man and then I’ve assumed that the partner is a woman.  Or maybe, and this goes a little bit away from the transgender side of things –

Matt:            No, no, no, it’s very important.

Kathryn:       As people understanding as well, they may say automatically, there may be somebody who has transitioned to female, so it can be a husband and wife but maybe from their understanding of the insurance world, they may think, “Well actually, the wife was born male – it was assigned male identity at birth, so they need to see male on the forms instead of female.”  It’s a very, very confusing situation for everyone.  I think it’s fair to say that the advisor’s going to be confused and the person who’s coming to you is confused because they probably don’t know exactly how these forms are going to need to be filled out.  So I think hopefully we’re going to sort of like debunk some of those things today.

Matt:            Yeah, great.

Kathryn:       So in terms of transgender, so that is the term that is used for someone that does not identify with their assigned gender at birth and I think sometimes people get unsure as to whether or not to use the term ‘transgender’ or ‘transsexual’.  So, transsexual is a term that was more used back in the day or sort of a bit of an older term.  A lot of people prefer to use the word ‘transgender’ now, instead of ‘transsexual’.  That’s not everybody.  I’m just saying that in general, people tend to prefer the word transgender because transsexual is more seen as if it was like a medical thing that was happening rather than it just being that this is someone and this is who they are.  Pronouns are something that I think a lot of people get quite confused by, especially on social media, you see quite a thing of people putting on that they may be ‘she’ or ‘she/her’, or ‘he/him’, or ‘they/them’.  And there’s quite a few other ones as well.

And I think it’s fair to say that most people don’t expect everybody to understand every single pronoun or version of sort of like the classification of a transgender or non-binary way that somebody would classify themselves because there are many, many versions.  One of the things that I have done in the past and just in case anybody would find this interesting, is that I found a website called LGBT Hero and essentially, I went on Google and I did, you know, one of those standard kind of searches saying like, ‘What do pronouns mean?’ or something like that. ‘How can I support people when they are using pronouns?’  And this website came up and I found it really useful because it gave really short, succinct descriptions.  It also gives you a list of all the different classifications that people might put to themselves.  And I think that’s really useful because there was far more on there than – I’ve heard more than what I’ve just said here, but there was more on there written down for me to read than I had actually ever heard of.  And there’s even some on there as well, I have to say, pronouns-wise, I’m not completely sure how I would pronounce some of them, because some of them I think – it’s like, one of them is the word ‘xe’ and – with an extra sort of like version to it as well.  And I’m not sure how to pronounce that, so it may well be that somebody says something to you about their gender and you’re not completely sure of how they want to be spoken to.  So it can just be quite a good idea to just say to somebody, be honest and just say, “Thank you, that’s incredibly helpful for me to know and I will use these pronouns for you.  Do you mind me just asking, just to make sure I’m going to be pronouncing it correctly?”

And if you’re really not sure, sometimes I think if you’ve written something down or if you’ve seen it in writing, it can make it sometimes stick in your head a bit more.  So you can always, I would say, just ask them to say, “So how would I write that pronoun down, if for some reason we are making notes and I can make sure that I write it down the right way for you.”  And I think the majority of people are quite understanding about the fact that if they are coming with a pronoun or a gender that you would maybe not be familiar with, that it’s something that they’ve probably experienced in quite a lot of places.  It’s probably not a shock to them that you don’t necessarily have that in the forefront of your mind but it’s your approach to how you accommodate and speak to that person afterwards that will be, in a sense, what gives them the feeling that you’re really supporting them.

Matt:            Yep, 100% agree with that Kathryn, very, very important indeed, I believe.

Kathryn:       Yeah.  So as I was saying, you know, when it comes to things like the gender, the assumption I say, because one of the things I do with the training with my advisors is, you know, I’ll –  when I do the role play training with them, which obviously as I’m sure everybody can imagine, everybody loves the role play training that I do. And they’re doing – there’s times where I’ll be saying to them, “Right, there’s this person”, and they’ll know, so I start it off by saying, “Right, you’ve got this man and he is married.”  So my advisors are trained to go, “Right,” so straight away they’re figuring out –“Okay –” so they’re speaking to me, they know automatically they’re a man and married, but they’re sort of like speaking to me, “Oh, and just to check you’re married”.  But they are trained to then be very careful with the wording to then say, “And does your partner have cover?”  So that we’re not going into, “Oh, so this is a man, he’s married, right, there’s a wife.”  You know, because I think there is still probably that stereotypical assumption that people do kind of in their mind have man, woman, woman –

Matt:            Absolutely.

Kathryn:       And, you know, obviously that may be what a lot of people have come across, but it’s just a little thing of just being really conscious in your own mind to say ‘partner’, rather than assigning a gender to the other person.  And then that’s really important to people who are transgender, but also people who are in relationships where obviously you maybe have two men in a marriage or two women in a marriage, just to make sure that you can then, as you’re chatting, you know, they will then refer to the partner’s name and so you can then start to really figure out and they’ll maybe use, as I say, the pronouns and things, and sort of like say – sort of like, “Oh well, she’s doing this at the moment, so unfortunately she can’t be on the phone with us as we’re speaking,” so straight away you know, “Okay right, so it is a gender identification of female.”  And it does feel a little bit unusual at first, I have to say, but as with anything, it’s learned experience, so once you’ve done it a few times, it becomes much, much more normal, when you’re saying it that way.  So hopefully that helps some people, a little titbit for people to take away.

Matt:            What’s interesting for me as an underwriter, Kathryn, and it’s valuable to hear that, so thank you, from an underwriter.

Kathryn:       I’m glad to hear.  So I think going back to some of the things that we’ve just been saying as well, I think because obviously, as I said, some people just don’t know what they’re going to expect when they come for insurances and I think that’s the same for a lot of people, if they’ve got any kind of situation where they think it might have an influence on the insurance.  And I do think that for people who are transgender, there is that kind of, you know, for some people, I think there is sort of like a case of, “What am I going to need to do, what gender am I going to need to put on these forms, what are they going to put it down as, is it going to go down a certain way on the form, what kind of terms am I going to be looking at?”

So I think a really good idea is to talk about the fact that things today are far, far better than they used to be.  As with most situations and hopefully most kinds of organisations and sectors, things are better than they were.  I’m not saying they are perfect, but a lot better than they were.  So I think a good starting point would be – because some people are going to have heard probably some horror stories from years gone past, Matt.  But maybe talking about many, many years ago, what would be the case, if somebody had come, many years ago, to the insurance world and said, “Right, I’m here, I’m transgender and I want insurance.”  What kind of questions would have been asked maybe and what kind of terms would have been maybe considered?

Matt:            Okay, well thanks for that difficult question, Kathryn.  Certainly, I’ll probably stay away from transgender just for a minute, but certainly in the height of the HIV scare, that was a very real scare for very obvious reasons, certainly the insurers used to ask very, very personal questions of men in particular.  It did go down to if you were a single man – which again is quite silly, now we think about it and if you were a single man, they would ask questions of a very, very personal nature.  Not only around maybe the different number of partners you’ve had, but what type of sex you actually engaged in.  Which frankly now, in the year 2021 and the way that the world and the insurance industry has moved on, are horrific questions to go around asking people, to be perfectly honest with you.

Kathryn:       It feels strange that, you know –

Matt:            I find it absolutely horrific, looking back on it.  I do –sorry Kathryn, I did interrupt you there.

Kathryn:       No, no –

Matt:            There is a part of me and a very small part of me now which would say, “Well, was it an overreaction?”  It certainly seems like it now, but if you are trying to protect a very large portfolio of business from a risk which was totally unknown really of what the end game would be then I’m afraid the only option would be to say – the only endgame option would be, you don’t touch anybody who’s a single male, as an example.  And therefore the underwriters in a way at that particular time were trying to give cover – at least they were trying to give cover – the approach – so the goal I think should be applauded.  The way that we actually tried to get to that goal is certainly now, and I believe it then, was totally unacceptable.

So life has moved on, I think, certainly the timing – I wasn’t quite sure of the timing when all these things kind of disappeared from the insurance industry, but I think you and I agree it’s at least around 15 years ago, it’s 2005 I think we talked about.  And I’ve not seen anything like that since.  But it’s – overall, underwriters I think, certainly of my age who lived through that type of underwriting process will look back on that as a lesson learned.

Kathryn:       Yeah.  Quite a lot of cringing.

Matt:            Indeed.  Do we hang our heads in shame?  Well possibly, but on the other hand, what else could we have done apart from decline an awful lot of people and just not give them insurance whatsoever which I don’t think is good for anybody, good for the market or anything.  So yeah, I generally believe that we’ve learnt from that.  I mean, legislation has come on board now thick and fast since those times, which only allows justifiable discrimination and that’s one definitely for another day, to discuss what justifiable discrimination actually means.  But certainly we’ve gone a long, long way from that type of intrusive questioning.  So yeah, all I would say is I think lesson learnt on that and thank God as well.  Would you see that in your own cases that you see and conversations that you see, Kathryn?

Kathryn:       Yeah, I mean absolutely.  So I think, as I say, I think Alan joined the industry around 2005 and I joined it in 2010.  And I’m sure I remember Alan saying that it was still in the application forms at least when he’d started.  I have a vague recollection of it being possibly even around the time that I joined but I don’t know if that was more a case of that I was looking at an older case and looking at the application form and going, “What on earth are they asking here?” kind of thing, because I understand what you’re saying because ultimately, insurers are businesses.  They have – they offer risk – they assume there are certain risks, but they have to maintain certain financial capitals.  If there’s suddenly a risk that they don’t have a lot of data on, very similar to Covid, then there is going to be quite a knee-jerk reaction, they’re not going to be really sure what to do and possibly, as you say, the questions that might in a sense go overboard, you know, it doesn’t negate how people would have felt at that time obviously going for insurance.

But it’s sort of like that thing, it’s not justified the way that the approach was done, but it’s – you can kind of understand.  I’m not saying that’s okay, for anybody who’s listening, I’m not saying it’s okay, but you can understand why the insurers were doing such a quick reaction because it was something new that they weren’t massively aware of, they didn’t have that long data.  And at the time, obviously because there was this fear of HIV and obviously there wasn’t the same medications and treatments as there are now.  Obviously HIV was certainly not what it is today.  And I think, you know, there is that fine balance between – I don’t think we should just bash insurers and underwriters and actuaries for the decisions that are made, it is that thing though of the learning experience.

So, obviously as the data has become available and as things are progressing, you know, obviously we’re now at a point where we’re seeing sometimes really incredible terms for people that are living with HIV.  So I think that’s a good example of how things have moved on in some ways, but obviously we’re not saying in the slightest that people who are transgender are men who potentially, you know, have HIV.  But I think it’s important to sort of just say that that’s potentially a situation that somebody might have experienced in the background – sorry, not in the background, some time ago.  But now it’s – it couldn’t be further from that, I don’t think.  There’s some things we’re going to be chatting about again where we’re going to be saying we’re not sure how we can necessarily fix this side of things, as we’re chatting a bit more, but there used to be a thing as well and I know this wasn’t too long ago as well and I think this has started to dwindle off since the gender pricing that became standardised.

So, for anybody who’s quite new to the industry, I can’t remember the exact year, I’m thinking 2016 but maybe I’m wrong, there was a specific legislation that came out that basically said that you couldn’t price differently for men or women in insurance.  Everybody had to have the same pricing.

Matt:            Time flies Kathryn, time flies.  2012.

Kathryn:       2012 oh wow, yes absolutely.  Something happened in 2016, I don’t know what, but something happened.

Matt:            No worries at all.  It’s just – isn’t it amazing though, how we remember these things and think it was like yesterday, when in fact it was years and years ago.

Kathryn:       It’s almost a decade ago. That’s absolutely – oh wow.

Matt:            I know, frightening isn’t it?  Either way –

Kathryn:       That’s a huge amount.  That means that actually – so yeah, that means I’ve just had my 10-year anniversary in the industry a couple of weeks ago.

Matt:            What can I say?  Congratulations!

Kathryn:       Thank you.

Matt:            You look well on it too, it has to be said.  No great big bags under the eyes, or anything else or, you know –,

Kathryn:       It’s the lighting on the Zoom, it’s photoshop filter.  No, it’s alright, I’m not using a filter  I need to though.  So yes – so basically, they used to do it where for say, life insurance, men used to be a charged a higher amount because the likelihood of a man dying at a younger age than a woman was higher and then in kind of reverse, women used to be charged higher for income protection, because the likelihood of a woman being unable to work due to health was higher than a man.  So they all kind of became equalised and nobody was allowed to do anything like that.  And I think probably since – so actually it will be – it’s still a while then since that happened then in 2012 but probably in the last few years or so, they’ve stopped asking for certain things.

So they used to ask quite a lot for gender reassignment certificates I believe with quite a few insurers to be able to actually – because I think this is probably one of the main questions, is like, “Right if I’m transgender and I was assigned a male gender at birth but I’m now a woman, what do I put down on these forms?  Do I put down male or female?”  Now what it used to be is that unless you have the gender reassignment certificate, you had to go down as the gender that you were assigned with at birth, but that’s no longer the case now Matt, is it?

Matt:            No, no, no.  In terms of a proposal form, you would put down the gender that you are – that’s legally attributed to you.  So if you’ve been transitioned to a woman, you put down a woman, you put female.  It’s really as simple as that.  So, no issues there, I don’t think.  Important to raise mind you, because I think it’s important people who don’t necessarily come across this type of thing, particularly with insurance, then I think it’s certainly well worth knowing.

Kathryn:       Absolutely.  And to know as well just that sometimes these things used to be asked for and those certificates may not be asked for now.  So just, you know, it may not be that we see people who are transgender regularly when we work.  So it’s that thing if sort of like it’s been a while, just make sure that you know, as with anything, make sure you know sort of like the latest rules and requirements and things like that.  But generally, as we’re chatting more, it would be good to obviously be able to get across that really actually being transgender is going to have very, very little impact upon the insurances, if at all.

But we’ll just sort of like chat a little bit then, I mentioned about how, you know, obviously potentially putting on these forms men and women, if you’re male or female.  Now I imagine that presents quite a difficulty for quite a few people now, obviously especially the people in the non-binary space, because we don’t have a non-binary option.  And I’ve been sort of like thinking and been trying to figure out why we don’t have a non-binary option.  Now I do know that when – well, I say I do know, I believe from my understanding that to make changes to the forms, for insurers to make changes to their insurance application forms, isn’t the quickest of things and that it maybe takes a while. Because it’s not just changing the form, it’s changing all the systems in terms of the recording and the databases and the different areas and obviously where they sort of like promote out if they don’t then also have a third section for offering a non-binary option then that in itself could, you know, there’s so many different technicalities that would need to happen.  It would really need to be I think, quite an industry effort to be able to do that.

Matt:            Totally agree with you on that, it has to be across the industry to do that, led by somebody like the ABI, or similar.

Kathryn:       Absolutely

Matt:            And you’re absolutely right, having lived in that insurer world, it is a big job even – particularly these days with the way that systems are tied up with underwriting systems.  So back-office systems with underwriting systems, it is quite a big job and with the push for new business, I’m afraid that box, if you like, is likely to come down the tree, in terms of pecking order.

Kathryn:       Yeah and priority is probably not –

Matt:            Absolutely.  So, you’re absolutely right, it’s a big change and you’d think it was very, very simple, but it’s not.

Kathryn:       I think another thing that stands out for me – so that’s one scenario obviously as to why, is the time and the resources that would need to be done, it’s not just a quick –

Matt:            And the priority it happens in.

Kathryn:       Change the paper form, it is huge technological changes, it’s not just within the insurers, it’s within platforms that kind of have the centralised application form, the price comparison site type situation, it’s getting all of those areas as well.  And then there’ll be some advisor firms who possibly have options where the forms are done on their website.  There’s so many areas that it would need to be done through.  It’s not a small task.  Not saying that it’s not important, it’s incredibly important, but it’s not a small activity for insurers to be doing.

But I think the other thing for me that stands out is how it could potentially influence things, especially within, I imagine, like the critical illness and income protection space, in terms of underwriting.  Because – and obviously decisions that are made – because obviously in some, you know, in some situations, so say like if somebody is female and they are going for critical illness cover and they happen to have maybe had – their Mum had had breast cancer at a young age, that could potentially influence the decision on the policy – depending upon the insurer, depending upon the really specific data.  I’m not saying this is going to happen to everybody, but it could well be that there could be a breast cancer exclusion on the critical illness contract for that person because of the family history.  Now, I don’t believe that you would necessarily get that the same, if that person was a male and had a mother who had had cancer.  I don’t think there would, there wouldn’t be a breast cancer exclusion, I don’t believe.  You could correct me Matt, right if I’m wrong, but I don’t believe there would be.

So then it’s that thing of, “Well, hang on, are we actually being – in some ways, are we actually being fair at all?”  Because that would mean that someone who was female and transitioned to male would actually have better terms for cover than someone who has remained female with the same family medical history.  And obviously there is a difference in the person who has transitioned to male as he probably obviously has taken testosterone and very different but then you have the other argument of, “Well if someone was male and transitioned to female, they have possibly taken quite a lot of female hormones, so would that actually in the end kind of increase the risk based upon the family medical history as well?”  I know that’s a lot of ifs and everything that I’ve just said all in one go Matt and I hope that everyone that’s listening has been able to follow it, but it does kind of feel like it doesn’t necessarily marry up at the moment.

Matt:            I think there are two very interesting points there.  I think that the European Gender Discrimination Act that came in in 2012, it never ultimately – well let me put it this way – and modern countries within the European Union possibly didn’t think through the complications of situations like we’ve just described.  It was supposedly a very simple, “Well men should pay the same amount of premiums of women, end of.”  But when you’ve got all of these side issues, very important but nevertheless side issues, then it becomes very, very complicated indeed.  And it’s a classic case for me of unintended consequences.  Absolute classic case of that.  So yes, you’re going to get situations like that where it is pretty difficult.  I mean, it’s an interesting one.  I mean, if you’re looking at females who transition to males and I suppose as you have just said, high doses of testosterone is a standard form of cross-sex hormone treatment.  And the side effects, no surprise including gain in body mass, increases in blood pressure and cholesterol and other side effects can also include osteoporosis, increased emotional lability, elevated liver enzymes and also, importantly, I think we may have touched on this, maybe from the outside though, and the development of hormone-related tumours.  Although the latter is pretty rare at the moment, so it’s a bit of a watching brief in terms of the insurance industry.

Now, the other way round, so male to female, as you again have said, treatment is usually with high doses of oestrogen, there’s an increase in visceral fat, and despite the fact of the levels of HDL have increased, the overall cardiovascular profile.  So if you think of men tend to die of heart attacks or sorry, cardiovascular disease more than women, similarly at certain ages, the overall cardiovascular risks profile of male to female transsexuals reduces implementation with the implementation of cross-sex hormone treatment.  So, I don’t think anything I’ve just said there would have been a surprise when you’re using male hormones or female hormones.  Those are the types of things you would expect in a male or a female.  But nevertheless, I think one of the important points you’ve just said that – and highlighted but I’ll also reinforce it, that if you are transgender and the key areas of underwriting that will be looked at are not that you are transgender whatsoever and if you’re transgender and free of any medical disorder, then you will get standard rates.  I can’t say everybody, because I don’t have sight of the whole of the UK industry.  But you will generally get standard rates for life, CIC, sorry, critical illness and also income protection.

Now, the underwriters will certainly look at psychological issues and they will obviously look at depression, anxiety, a history of, or that continuing after a transgender operation.  And obviously they will also look at associated lifestyle issues which sometimes go along with mental health issues such as alcohol abuse and drug abuse as well.  In terms of an operation, if you are looking to have the operation, then yes, life cover will be generally postponed in line with any operation of a similar risk, okay?  So it’s not a special transitional gender reassignment loading or risk or postponement, it’s the same with anybody else who’s having an operation of a similar medical risk.  A surgical risk.  Of which there are, for some operations, you have to face that.  In terms – and what underwriters will generally want there is just a sign-off from the treating surgeon that everything has gone well and there are no complications and you go on your merry way with standard rates, normal terms.  Again, the psychological issues are treated the same as any other person who has anxiety, depression or suicidal – God forbid, suicidal thoughts or anything like that.  They will be treated exactly the same as anybody else.  So the fact that you’re transgender does not make a difference in the context of risk.

Kathryn:       Yep.  I think it’s quite interesting that one, I’m really glad you’ve brought that up, because I think one of the big things that can sometimes be seen as sort of like a little bit – nothing that you’ve said but, you know, just generally something that can be seen as offensive to people that are transgender is that somebody saying that it’s something to do with mental health.  Because, you know, it isn’t mental health and I think – but there is a really difficult distinction when you’re doing these forms, especially as an advisor or for anybody who is involved.  Because a little while ago, we were helping somebody to get insurance and they were somebody who was transgender that transitioned, they’d had the surgery and everything.  And we were going through the application form and obviously being transgender isn’t a mental health condition, however, this person was really insistent that we put it down as a mental health condition.  And we were trying to be – obviously we were being really supportive and just saying, “Look, it isn’t classed as a mental health condition in the insurance world, you know, yes we will put down that you’ve had an operation, because timing-wise it was a case of, ‘Yes, we’re going to put down that you’ve had an operation, but it doesn’t need to go down as a mental health route.’”  But they were very much of the opinion that for themselves, that it was a mental health condition for themselves and that was kind of part of the whole thing for them.  Which was quite unusual, because obviously I think when you do do training in this, you are trained not to think of it as a mental health condition.  So for somebody to say it really is, it felt quite strange actually to complete the form in that way.  But I think it’s really important just that people are, you know, especially advisors, they’re aware of that, they may face that.

But on the other side of that, the difficulty is as well, is that a lot of people who will have been through surgery, especially if it’s been performed in the UK, will have seen a psychiatrist.  So, it will go into the mental health question set, there’s no way of us avoiding that, because it will be in the – and obviously we’ve always got our list of questions – “Have you ever had – have you in the last five years, have you in the last three years, have you in the last three months?” kind of situation, when it comes to these questions.  So in the ‘have you ever had’, the psychiatrist question is probably going to be there.  So you’re going to straight away answer that, at which point, you’re going to need to say why.  At which point you’re going to have put down transgender as the reason why and probably go through all the usual mental health question set.  And I think as an advisor, what we would need to – what I would suggest people do if they are facing that situation, is something that I do a number of times with different things that I see that come up in these question sets, is I apologise on behalf of our industry and just say, “Look, I’m really sorry, but this is the way that the insurers’ application forms are set up.”

So as soon as we know there’s a psychiatrist involved, there’s an automatic assumption there’s a mental health condition and so we need to ask all those questions.  And as soon as we say there’s a mental health condition, I have to ask you all of these.  It doesn’t matter in a sense, even if it was just mild anxiety that you’ve had, I’m going to need to ask all of these quite, potentially intrusive, mental health questions, to be able to get the insurances for you.  I don’t really think that there’s a way for us to get around that.

Matt:            I think first of all, you were right that if the proposal form question does actually ask about, “Have you ever seen a psychiatrist?” then I would certainly encourage people to say ‘yes’, but give an explanation as to why.  “This was part of a gender reassignment process, end of.”  Now, I think you will find – you should find with good underwriters that they would actually see that as a positive, not a negative, as part of – that the individual concerned is actually looking after their mental health and freely discussing how they feel.  I will just reiterate the fact that it would be seen as a positive to an underwriter.  A positive answer to a question doesn’t count against the individual whatsoever – the client whatsoever.  It is an underwriter trying to understand the risk, if any, that they are actually facing.  So I think the person who looks after their mental health – so it’s a very, very good sign.  And I would certainly endorse, 100%, that the underwriting fraternity do not think that transgender is a mental health issue.

Kathryn:       Yeah.

Matt:            It is a fact, sadly, that a number of people who do enter the kind of gender dysphoria and then decide to transition over, do have anxiety and do suffer – and that may move into depression and so on and so forth and that’s a very sad thing.  But also perhaps to be expected from such a huge change in their life –

Kathryn:       Absolutely.

Matt:            And, as I say, underwriters are aware of that and the actual condition of anxiety or depression or whatever, is treated exactly the same as anybody else.  Just in inverted commas, that it is a transgender, it does not make a difference.  And as I say, positive, “I’ve seen a psychiatrist because of the gender transition,” is a positive, it’s certainly not a negative.

Kathryn:       Absolutely.  Thank you.  Well I’ve got a case study to just quickly go through.  We’re coming towards the end of the episode now.  So it is an example of somebody who is transgender that needed some insurance, so we spoke to a couple and it was a male and female life.  The male had been a female many years ago and had transitioned to being male and they were in their mid-thirties to early forties.  So what they needed was some cover for their mortgage so we did them some joint decreasing life insurance of around £312,000 over 22 years and the premium was just under £35 a month.  And what’s to be clear on that as well, is that that was what’s classed as ‘normal terms.’  So normal terms is that the premiums haven’t been affected at all by the disclosure.  So that would include obviously having had the surgery and seeing a psychiatrist as well.  And also, for the male life, you know, he needed some income protection.  So it was about £3,000 per month, we had a 13-week deferred period to age 60 with a full claim length and that was around about £83 per month at a guaranteed premium.

What’s important about that one as well is that there was an exclusion on the income protection, just to be very, very clear and transparent but that was because – well he had had a shoulder injury a couple of years beforehand, I think it was, sort of like some kind of sporting shoulder injury.  And so he ended up with a shoulder exclusion on the policy.  Which – so again, nothing at all to do with being transgender, but as with many people, or I would say a significant majority of people if they’ve had something in terms of a shoulder injury and they’re wanting income protection, most places are going to be seeing an exclusion on there, at least for a certain time period.  It has potential sometimes that you can ask it to be a reviewable exclusion, it depends upon the insurer, depends upon I think, maybe how sunny it is on that day, as to whether they want to do it or not.  But yeah, that’s sometimes –obviously that’s just a good example of what we can see where as I say, you’ve got life insurance, say you’ve got income protection and really, in terms of the actual – as I say, the transgender side of things, it’s been no influence whatsoever upon the cover.

So, we are at the end of the podcast.  It’s been really, really lovely to chat to you again Matt, it’s always great to get your insights.

Matt:            Well thank you, Kathryn.  Thank you for inviting me, as always.  A fascinating topic and I think – I hope that we’ve put some – those clients – those people out there who have transitioned or are thinking about transitioning have built up their knowledge and they feel confident in applying for insurance.  Because they should do.

Kathryn:       Absolutely.

Matt:            We are not the ogres we were perhaps once seen as.  You know, we’ve matured and we look forward to receiving the business.

Kathryn:       Absolutely.  I think you’re completely right.  I think, you know, as long as we say to people as well, just depending upon the situation, you know, sometimes be patient, obviously, the insurance world is doing incredibly well.  Advisors are doing incredibly well.  Lots and lots of departments are in terms of trying to be much more aware, much more understanding.  You know, if somebody isn’t necessarily using your preferred pronouns at first maybe, you know, just obviously make them aware of you prefer to be addressed and obviously, possibly have a bit of patience.  Obviously at the same point, if someone is just being downright rude and ignoring you, then absolutely don’t be happy and tell them that you’re not happy.

But it’s one of those things that we’re all growing, we’re all learning and I think sometimes unless you’ve actually experienced speaking to somebody living in this situation, it can be quite hard.  We can know about these things, but actually living it and experiencing it and knowing how to actually speak to somebody in a situation can sometimes be – can be – it can just be something people aren’t used to and we are creatures of habit, we’re creatures of learning and it’s certainly something that I do as well, really within our industry, really, really hope that people do take the time to just sort of maybe do a little bit more in terms of looking up these different things – these different pronouns, the different types of classifications when it comes to gender and I know some people are possibly quite – I think some people are possibly still quite guarded and are probably still very much, “Well there’s men, there’s female.  I can maybe see non-binary, but I’m not having 20 versions of non-binary.”  And I think it’s important to sort of like say that it’s really not – it doesn’t affect you to be more aware of it but it would really affect the person that you are speaking to.  So it’s just extremely important to just maybe even just give it a once over, just a quick look over things and just make yourself a bit more aware.

I’m going to be back in a couple of weeks’ time with Roy McLaughlin and Joe Elphick from L&G.  We’re going to be discussing group insurances and again some stuff about gender as well.  If you’d like a reminder of the next episode, please drop me a message on social media, or visit the website practical-protection.co.uk and as always, don’t forget that if you’ve listened to this as part of your work, you can pop on over to the website and claim a CPD certificate too thanks to our sponsors OctoMembers.  So thank you very much for your time today, Matt.

Matt:            My pleasure.  Look forward to speaking to you again.

Kathryn:       Look forward to speaking to you, too.  Bye.

Matt:            Bye.

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