Last year I filed a discrimination case with the Dutch Human Rights Institute (College voor de Rechten van de Mens) against insurance company Unive for refusing to fully cover hair removal therapy for intersex individuals where they do fully cover this procedure for transsexuals. During the hearing at the Human Rights Institute in Utrecht on November the 25th the representative from Unive was asked to justify its decision. Unive's response was that they were just following the ruling by the central organization for health insurance companies in the Netherlands, CVZ. According to CVZ the situation for transsexual and intersex individuals when it comes to such a therapy is vastly different.
This therapy involves the removal of facial hair in a permanent fashion for individuals who wish to transition to a female role, but have had sufficiently high testosterone levels that they began to develop facial hair at some point. After lowering testosterone levels this hair growth does not stop by itself, ergo this therapy is required. Why the situation for transsexuals (who 'choose' to transition) and for intersex individuals (who are born like this) when they move towards a female role would be different is something which was asked by the Human Rights Institute after the hearing to CVZ and the Dutch Minister of Health. After a long delay of many weeks because bureaucracy is a busy process, I recently received the answer from the Minister of Health, Edith Schippers, or more specifically the director of health insurances, drs. G.G.J. Ikkink.
The Minister of Health got asked a total of three questions, the first one being: 'Do you share the opinion of the CVZ? Please further motivate your answer to this question.'
The response says that they support this opinion of CVZ, because it fits with the regulations concerning the health insurance law.
The second question: 'Could you provide further information or explanations regarding the relation between the CVZ and the Minister of Health, in particular whether the Minister of Health can provide mandatory instructions on the question of how this health insurance law can be interpreted?'
The response basically details how the Minister of Health determines the extent and scope of health coverage. CVZ hereby has the duty to explain and interpret this law, whereby the Minister of Health can not force CVZ to change its interpretation because the healthcare law does not include such a provision.
The third question: 'During the development of the healthcare law, did the coverage options for a person with an intersex condition, such as in the relevant situation, get determined or considered? If so, can you detail this?'
The response denies that any such consideration was made for intersex individuals. They claim that because intersex individuals are not named specifically in the relevant law, this therefore does not apply to such people. It is made clear that at no point in the decision process intersex individuals were ever considered.
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What is striking about this response is most of all that if you put the actual law article next to it ('Besluit zorgverzekering', article 2.4, first member, part b) [1] it never actually mentions transsexuality except for the fifth item in relation to sex-reassignment surgery. The first and second item are decidedly neutral in their formulation:
1°. afwijkingen in het uiterlijk die gepaard gaan met aantoonbare lichamelijke functiestoornissen;
(aberrations in one's appearance which are due to measurable physical functional disorders)
2°. verminkingen die het gevolg zijn van een ziekte, ongeval of geneeskundige verrichting;
(mutilations which are the result of disease, accident or medical actions)
Transsexuality falls under item 2, due to the need to remove facial hair in the case of a male to female transition which is the result of medical actions (hormones, surgery). The hair removal therapy is thus part of the whole medical procedure of the transition.
An intersex case whereby one wishes to portray a female role while suffering from excess facial hair would fall under both items 1 and 2, as often medical actions are involved, though it's also due to physical characteristics which one was born with which could be classified as a disorder.
For the Dutch Minister of Health to thus defend the decision by CVZ to reject coverage for intersex individuals and to pretend that that it only covers transsexuals despite the law itself being completely neutral in its construction is simply patently ridiculous. It further suggests a more widespread and fundamental discrimination against intersex individuals, something which I have encountered among the Dutch medical community between 2005 and 2013 in a very significant manner as well.
At this point I'm very curious as to what the response from CVZ to a similar set of questions as those listed above will be. If they are indeed the final authority on interpreting and explaining healthcare laws then they should be able to provide us with a reasonable, well-reasoned explanation for why they found that the above law article's members can only be explained as applying to transsexual individuals.
CVZ had until February the 3rd to send in their answer. As soon as I receive my copy of their letter I will update my blog with the details.
Maya
[1] http://wetten.overheid.nl/BWBR0018492/geldigheidsdatum_14-02-2014#Hoofdstuk2_1_Artikel24
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