Gender affirming surgery (GAS), also referred to as sex reassignment or gender confirming surgery, is an insured benefit in Nova Scotia (NS). Coverage for GAS is consistent with what most other provinces insure and so are the processes used to provide access to care.

The funding will help those who are deemed eligible and for whom the surgery is an important part of their gender transition. Counseling, psychotherapy, and hormone therapy continue to be funded when provided in public institutions in NS.

GAS can be categorized into three areas:

• Removal of the internal and external organs associated with the current sex
• Construction of the external characteristics of the desired sex
• Procedures to enhance the appearance and more closely match the desired sex

What's covered

The location where the procedure is performed will be determined on a case-by-case basis and will depend upon the nature and extent of the surgery and the availability of surgical expertise.

List of insured GAS when they are performed in approved locations:

Only available in NS	Available in NS and Centre Metropolitain de Chirurgie in Montreal	Available only in Centre Metropolitain de Chirurgie in Montreal
Hysterectomy	Orchiectomy	Phalloplasty
Oophorectomy	Penectomy	Metoidioplasty
	Breast Augmentation	Vaginoplasty
	Breast Reduction
	Chest Masculinization / Mastectomy

What's not covered

A complete list of coverage exemptions can be found on the Gender Affirming Surgery Approval Request Form / Application (PDF)

Who is eligible

Clinical eligibility for GAS will be determined through application of the World Professional Association for Transgender Health (WPATH) Standards of Care (SOC) criteria. You can be assessed by your physician, specialist, nurse practitioner (NP), or health care professional (HCP) with required competencies and skills to assess, refer, and treat gender dysphoric patients as outlined in the WPATH SOC. This is a typical assessment required by other Canadian jurisdictions that insure these procedures.

Application process

Once you have been deemed eligible for surgery by your physician, specialist, NP or HCP with required competencies and skills to assess, refer, and treat gender dysphoric patients as outlined in the WPATH SOC., and approved by MSI, they will work with a medical team to develop a surgical plan.

If you are interested in accessing GAS, you are encouraged to contact your family physician, NP, specialist, or community mental health team in your area. If you do not have a primary care provider or connections with care providers listed above, contact prideHealth who can help you to navigate the system and find appropriate providers for your GAS application. They have also developed pathways to help you understand the process available at: https://library.nshealth.ca/TransGenderDiverse/Home.

To be approved for public funding, you and your physician, specialist or NP must complete a Gender Affirming Surgery Approval Request Form / Application prior to having surgery.

Those seeking out-of-province coverage (see above table) and travel require pre-approval by MSI via the Gender Affirming Surgery Approval Request Form / Application.

Out-of-Province surgeries will only be approved for funding if they are to be performed at the Centre Métropolitain de Chirurgie Montreal, Quebec. For eligible individuals who travel to Montreal for GAS, many costs directly associated with the procedure are covered and also include transportation and accommodation costs as per the Nova Scotia Out-of-Province Travel and Accommodation Assistance Policy.

For questions about the approval process for these surgeries, please contact MSI (in Nova Scotia) toll free at 1-800-563-8880, or email at: MSI@medavie.ca

To speak to someone directly about this coverage, please contact the Department of Health and Wellness at: 1-877-449-5476 (toll free) or 902-424-7538.