OGH: Health Insurances May Not Refuse Cost Coverage for Gender Reassignment
The exclusion of risk by the "muki Mutual Insurance Association" deprives transgender and intersex individuals of the opportunity to "undergo a medically necessary gender reassignment with coverage by the insurer," it was explained. Specifically, the VKI objected to a clause in the General Conditions for Health Costs and Hospital Daily Allowance Insurance, which excludes such procedures from insurance coverage.
OGH Overturned Insurance Clause Against Gender Adjustment
The OGH prohibited the discriminatory clause "The following are not considered insurance cases: [...] gender reassignment," which generally excludes such procedures performed on insured persons from insurance coverage, even in the presence of a medical condition and necessity for treatment. The clause excludes every insured person from the benefit, but in reality discriminates against intersex and transgender individuals, because gender adjustment is only relevant for this group, argued the Supreme Court.
The clause thus violates Paragraph 1c of the Insurance Contract Act and the Equal Treatment Act. The OGH also clarified that insisting on the incriminated clause by the insurer would be unethical.
Ruling as Anti-Discrimination Protection
"The ruling is of fundamental importance, advances anti-discrimination protection in insurance law, and significantly improves legal access for affected individuals," said Petra Leupold, Chief Legal Officer at VKI. The OGH thereby extends "the prohibition of discrimination enshrined in the Insurance Contract Act for the first time to transgender and intersex individuals."
"The ruling provides legal certainty for people who have previously been disadvantaged in accessing private health insurance due to their transgender, intersex, or non-binary status," emphasized Sandra Konstatzky, Head of the Equal Treatment Advocacy (GAW). The Equal Treatment Act prohibits discrimination based on gender in access to goods and services, including private health insurance. For advisory practice, the OGH decision means "that we can resolve discrimination cases more effectively and quickly out of court. This is a tremendous relief for affected individuals."
(APA/Red.)
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