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Health insurance companies have to pay for breast enlargement in transsexuals
The Federal Social Court in Kassel upheld a lawsuit from two transsexuals. People who are transsexual are entitled to reimbursement from their health insurer for covering the cost of clinical breast augmentation, the judges said. Finally, the legislator makes an exception to transsexualism under certain conditions. The decisive factor is whether a previous hormone treatment had little or no effects.
"In male-to-female transsexuality, breast enlargement only comes into consideration if either the gender reassignment surgery with the removal of the male gonads did not lead to an acceptable growth of the breasts or if a gender reassignment surgery should not be carried out at all?" This question today went to the federal social court in Kassel and ruled in favor of the applicants.
Man-to-woman transsexual entitled to breast augmentation
If women want to have breast augmentation done for aesthetic reasons, they have to pay the costs out of their own pockets. Breast surgery with implants is not part of the service catalog of the statutory health insurance companies, according to common case law. As the Federal Social Court in Kassel ruled today, transsexuals (man to woman) are in principle entitled to the financing of a medical breast enlargement if the minimum targeted body size has not been reached by hormonal treatment. However, the prerequisite for this is that the hormone therapy has not worked so far and that the size of the body has not reached A, as the top social judges judged.
The judges based their view on the fact that the legislature recognized an absolute exception to transsexuality. In order to “reduce the psychological suffering” of the person concerned, the patient is exceptionally entitled to treatment even during an “intervention in healthy organs”. In addition, the judges emphasized that a previous conversion of the genital organs was not necessary for the claim (file number: B 1 KR 9/12 R and B 1 KR 3/12 R).
Checkout refused to pay the cost of the operation
The court heard two cases. In the first, the health insurance company had covered the therapy costs of a 62-year-old applicant for hormone treatment and the conversion of the genitals. However, because only very small breast attachments had formed despite the administration of hormones, the woman applied for the cost of implant surgery for the plastic manufacture of a female breast. Surgical breast augmentation was rejected by the health insurance company. Health insurance argued that “surgery on healthy organs” was not in the benefits catalog of the statutory health insurance companies. Therefore, such "cosmetic surgery" is fundamentally not funded.
In the second case, the health insurance company had already paid for hormone therapy, surgical feminization of the face and two procedures to change the height of the voice. The assumption of costs for the removal and conversion of the genital organs had already been approved, but had not yet been used by the applicant. Again, the health insurance company refused to pay for breast augmentation. However, the health insurance fund argued that genital surgery could also result in hormonal conversion, which would result in breast enlargement. Therefore, this operation should have preceded before deciding on breast surgery.
Breast surgery if body size A was not reached by hormone administration
Both patterns of argument were rejected by the top social judges. Because the legislator sees an exceptional position in transsexuality, the health insurance companies have to finance a breast conversion under certain conditions, even if it is actually a healthy organ. However, this judge's decision only applies if body size A has not yet been achieved, for example, by administering hormones.
If the breast size has already been reached, it is an “undoubtedly gender-typical area”. Then there is no longer any entitlement to funding from the health insurance fund. Therefore, the first complaint was again referred to the State Social Court of Hesse for review.
Genital surgery is not a requirement
In the second case, the federal social judges decided that the health insurance company should not require a previously undertaken transformation of the genital organs. The Federal Social Court referred in its reasoning to a previously made judgment of the Federal Constitutional Court. Accordingly, it is no longer necessary for a name change to have a solccurous operation performed. (sb)