Coverage of Costs for Phalloplasty Abroad

Facts

A., born in 1988, suffered from gender dysphoria in the sense of female-to-male transsexuality. After various medical treatments in Switzerland, the costs of which were covered by the SWICA health insurance company, SWICA, however, rejected the coverage of costs for the operations for penis construction (phalloplasty) as they were carried out abroad in Germany.

The Administrative Court of the Canton of Schwyz obliged SWICA to cover the costs for the phalloplasty performed abroad. SWICA then filed a complaint with the Federal Supreme Court, requesting the annulment of the lower court's decision and the confirmation of its rejection of benefits.

Considerations

The Federal Supreme Court states that according to case law, an exception to the territoriality principle under Art. 34 para. 2 of the Health Insurance Act (KVG) is only possible if there is no treatment option at all in Switzerland or if, in the individual case, a therapeutic measure practiced domestically would entail significantly higher risks for the person concerned compared to the foreign treatment alternative and thus a medically responsible and reasonably feasible, i.e. appropriate, treatment in Switzerland is not guaranteed.

The Federal Supreme Court finds that phalloplasty is also practiced in Switzerland. However, the dispute revolves around the question of whether a penoid…