Gender is an important part of how we express our identity in the world, and it’s more complex than a simple binary. While there’s a broadening cultural understanding of a range of gender identities that include transgender and non-binary people, the life insurance underwriting process hasn’t caught up with all the nuances.
You won’t be turned away from accessing life insurance for being transgender, but it can be more challenging to navigate a system built for a cisgender, M/F profile.
For the purpose of this article, transgender includes trans women, trans men, non-binary, agender people and anyone else whose gender identity does not align with their sex assigned at birth.
Until the broader industry refines its processes of working with applicants across the gender spectrum, it can take a little extra thought for transgender people to fill out an application. Here’s what you can expect from the process. (And here’s a full rundown of the questions you might be asked on your life insurance application.)
When you’re filling out a life insurance application, you’ll be asked to indicate your gender or sex almost immediately.
Life insurance asks for the applicant’s sex to help them determine life expectancy, according to Randy VanderVaate, president and owner of Funeral Funds. “Most life insurance companies have traditional options for gender on their application forms, with only male and female to choose from. Very few companies provide options other than male and female for gender.”
It’s worth noting that life insurance applications and agents you talk to may at times conflate the words “sex” and “gender,” but typically life insurance applications are most concerned with sex assigned at birth. Even if you’ve updated your legal gender, underwriters are generally trying to calculate the likelihood of you dying in a certain time period—and that is statistically correlated with your assigned sex at birth.
For cisgender applicants, all else being equal, data indicates that women live longer than men on average. Insurers use this correlation between assigned sex at birth and life expectancy as part of their formula to set policy rates.
Life insurance providers don’t all use the same processes to assess applications. Some may ask you to indicate assigned sex at birth for underwriting purposes (i.e. assessing your application details for your risk and deciding what policy rating to offer you), while others may underwrite you based on your identifying gender.
Some life insurance providers may look at factors like the medical transitional care you’ve received to determine which gender category to use to underwrite you. A representative from the life insurance provider you’re considering should at least be able to answer whether it’s best to indicate your assigned sex or identifying sex on your application.
Katie A., of Pennsylvania, says their experience buying life insurance was not especially memorable—in a good way. Katie bought a policy before using gender-neutral pronouns. Their husband applied for life insurance after transitioning, including updating legal documents, and had no trouble having the insurance provider process his application for a male profile.
If you’re non-binary, chances are likely that you’ll have to apply under your assigned sex at birth. If you’re transgender, it’s worth asking a few different companies how they would process your application, so you can go with the provider that feels most comfortable for you.
Anti-discrimination laws in many states forbid life insurance companies from denying applicants on the basis of gender. The type of legal protection varies, so use a resource like the Transgender Law Center to learn the specific laws in effect in your state. It’s also important to address that even if transgender and non-binary people can’t be denied for their gender alone, they may still have a harder time getting a life insurance policy than cisgender people.
That’s because people in marginalized communities may report higher rates of mental and physical health conditions. They may face systemic and personal discrimination, face additional struggles with securing basic needs such as safe housing and have a harder time accessing safe and affordable healthcare.
It is entirely understandable that the increased social stigma and discrimination people with marginalized gender identities face could reflect in higher rates of mental health conditions like depression. Unfortunately, it’s also possible that serious mental health challenges could affect your ability to get life insurance coverage. Current mental health guidelines from the American Psychiatric Association explicitly state that gender dysphoria is not a mental disorder.
Insurance providers take major depressive disorder diagnoses or suicide attempts extremely seriously. Depending on the severity of a condition, an insurance provider may reject an applicant outright. Someone with a mild to moderate mental health diagnosis that is well managed may have a better chance at being approved.
If you have a mental health condition, showing that you’re following a prescribed treatment plan can help indicate that you’re managing the condition well. Some diagnoses or episodes of psychiatric care can also have a greatly diminished impact on your application over time, so a rough mental stretch won’t follow you forever. It’s certainly worth applying, as you may well be able to receive coverage.
A person who has faced refusal of treatment, mistreatment or hostile interactions with health care providers may avoid the health care system when possible. This could result in higher likelihood of health conditions going undetected or untreated.
Whether you fall into a male or female classification can also make a difference in some health-related underwriting considerations. For example, life insurance providers may use BMI as a tool to measure recommended weight ranges. BMI weight standards differ based on sex, so an individual may fall into a different weight category (e.g. normal weight range vs. overweight) depending on whether that weight is assessed for a man or a woman. Factors like blood pressure and cholesterol levels may also be perceived differently on a medical assessment based on male or female categorization.
Gender-affirming healthcare can be a significant way for some people to feel comfortable and improve their overall health and well-being. There’s widespread evidence to support improved mental health when people access gender-affirming medical treatments. But it can feel hard to predict how medical treatments like hormone medications or surgery will affect what you pay for life insurance.
Underwriters work to assess your overall risk as an applicant. Medical history is a big part of that risk profile. It’s important to be open about your history and any medications you’re taking, including from a black market or gray market source. As a general rule, insurers will not report you to authorities for admitting that you take illegally obtained substances. Hiding a medical issue could lead to the company denying your claim due to misrepresentation.
“Since a preliminary prescription drug history is usually a part of underwriting any life insurance policy, there will most likely be a follow up asking for doctors’ notes regarding the nature of the surgery and what the drugs are being taken for, since many drugs used in hormone therapy are also used in the treatment of various other diseases, such as cancer,” says Duncan France, a life insurance agent and owner of the Duncan France Agency.
He says, “The check is more about due diligence to make sure we aren’t missing something major, like a cancer diagnosis or treatment, which could make you ineligible for a period of time.”
If you’ve had gender-affirming surgery, some life insurance providers may be cautious about issuing a policy for a one- to two-year “look-back” period afterward. Meaning, even if your application would otherwise be approved, some providers will not issue a policy within one or two years of you getting certain kinds of surgery.
This is to account for potential complications or follow-up surgeries that you may need. After that window passes, the surgery may have a much lesser impact on your application. Other providers may not use the same look-back period for certain surgical procedures. If you’re considering surgery and life insurance, it may be worth thinking about what timeline makes the most sense for both your health and access to life insurance coverage.
Some people with marginalized identities have understandable reservations about interacting with healthcare providers. Not all medical providers offer a safe and accepting environment, and transgender people may have faced past discriminatory experiences that make them less than eager to undergo another exam.
Fortunately, there are some options to find life insurance without going through a medical exam. Some term life insurance providers offer a feature where applicants who qualify can skip the physical exam. You’ll typically still fill out a detailed medical questionnaire to provide your history, but it’s a way to avoid an in-person visit.
Other options include simplified issue or guaranteed issue life insurance, which don’t require health exams as a rule, but these are much more expensive than term life and typically offer much lower coverage amounts.
Although the life insurance industry has a long way to go toward including transgender and non-binary people, learning more about the application process can make it easier for you to find a life insurance option that makes you feel comfortable. Even as you navigate the sometimes thorny terrain of applying for life insurance, it’s worth keeping your ultimate goal in mind: protecting the people you love.
Fabric exists to help young families master their money. Our articles abide by strict editorial standards. This article has been reviewed and approved by a compliance professional who is a licensed life insurance agent.
This material is designed to provide general information on the subjects covered. It is not, however, intended to provide specific financial advice or to serve as the basis for any decisions. Fabric Insurance Agency, LLC offers a mobile experience for people on-the-go who want an easy and fast way to purchase life insurance.
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