The Insurance Court arrives in the same conclusion as the Ombudsman for Equality: The change of a personal identity number cannot be considered a prerequisite for the special reimbursement of hormone replacement therapy (27 January 2015)

People undergoing gender change have faced problems in qualifying for special reimbursement for hormone replacement therapy. KELA has issued a decision based on the Health Insurance Act on the medical prerequisites which the patient's condition must meet in order for him or her to qualify for the special reimbursement of medical treatment.   According to the decision, hypogonadism is considered to first manifest on the date of confirmation of the sex change and the amendment of the personal identity number to correspond to the new gender. 

The Ombudsman for Equality first reviewed this matter as far back as 2008. In its statement, the Ombudsman noted that a practice which determines eligibility for reimbursement based on a personal identity number instead of medical grounds places transgender people in a different position than other people. The Ombudsman recommended that KELA amend its reimbursement criteria so that they do not lead to the discrimination of transgender people in the reimbursement of medical costs. After the statement, the Ombudsman continued to highlight the matter in its meetings with KELA representatives. KELA waited for the ruling of the Insurance Court before amending its decision. 

In its ruling of 9 September 2014 (VakO 3394:2012), the Insurance Court found that KELA had acted in excess of its jurisdiction when it had ordered that the legal confirmation of gender change and the amendment of a personal identity number were prerequisites for eligibility for the special reimbursement of the medical treatment of severe hypogonadism. KELA amended its guidelines following the Insurance Court's ruling.

13.04.2016