Authors: Isabelle Melcher & Kai Jannik
First of all, it should be noted that health insurance providers in Germany are obliged to provide benefits in terms of actual treatment and support (including body altering measures). Unfortunately there is currently a large discrepancy in content between the “S3 Guideline – Gender Incongruence, Gender Dysphoria and Trans Health: Diagnosis, Advice, Treatment” (by the Working Group of the Wissenschaftlichen Medizinischen Fachgesellschaften e.V. – AWMF) and the “Assessment Instructions – Gender Reassignment Measures in Transsexualism” (by the Medizinischer Dienst des Spitzenverbandes Bund der Krankenkassen e.V. - MDS), which concerns the necessary requirements for measures to be taken. Therapeutic work is primarily based on the “S3 Guideline”, but should not ignore the requirements of health insurance providers in the “assessment instructions”. Employees of health insurance providers and doctors at the MDK generally adhere closely to the requirements of the assessment instructions. This should therefore be strongly taken into account when formulating indication letters and specialist reports.
The health insurance providers’ obligation to provide benefits applies to all medical and therapeutic measures that are associated with an established state of suffering. This unfortunately means that there must be a corresponding therapeutic indication for all measures. For individual measures, health insurance providers repeatedly request up to two additional psychological or psychiatric reports. The following benefits are explicitly named in the assessment instructions: hormone treatment, epilation treatment, genital reassignment surgery and breast surgery, voice and larynx corrections as well as aids such as wigs and epithesis. Measures not explicitly named in the assessment instructions must either be very well justified or are generally considered to be “cosmetic surgery” (operations that are not medically necessary), which you have to pay for yourself.
Last updated: 02/26/2021 - 11:03