Does Insurance in India Cover Gender Reassignment Surgery?

It had been 23 years and Taksh was tired. She wanted to be herself. Born with male genitalia, Taksh went to her parents and told them it was time. Her parents, both doctors, contacted Dr. Richie Gupta at Delhi’s Fortis Hospital and set a date for early 2018. Taksh got a gender reassignment surgery (spoken of as a ‘sex change surgery’ or SRS in common parlance), for about Rs. 4-5 lakhs.

Taksh is one of the few lucky ones who could afford this life-changing procedure. Gender reassignment surgery is performed to transition individuals with gender dysphoria (a condition where a person experiences discomfort or distress because there's a mismatch between their biological sex and gender identity) to their desired gender. This can include breast augmentation or reduction, construction of new genitals, and facial feminisation or masculinisation plastic surgery—the latter often being the most expensive part of the transition.

According to the 2011 census, India has nearly 5 lakh people who identify as transgender. The numbers should be considerably higher now. And, even in urban areas, 50% of the transgender community makes less than Rs. 8,500 a month, considerably lower than the national average income. How does one, then, spare Rs. 5 lakh? Especially when the Life Insurance Corporation of India, the biggest insurance provider in India, as well as the private insurance companies, considers sex realignment as a cosmetic surgery—on par with those getting nose jobs.

Poonam Rungta, a certified financial planner and LIC agent, told VICE, “Medical insurance doesn’t cover sex reassignment as it’s a cosmetic surgery, not a natural surgery. Sometimes, even before getting the risk cover after prior surgery, a panel of doctors checks your reports produced by an agency, and depending on whether they deem it risky or not, cover is provided of general medical ailments.”

The gender-affirming procedure as cosmetic vs natural has been a long-debated topic, one which continues to disenfranchise a large portion of our population from what they deem their natural right. Adolescents and adults with gender dysphoria are at increased risk for depression, substance abuse, and suicide, but working past it continues to be treated as a cosmetic change.

More importantly, what then, is the point of having third gender as an option while getting insurance? Granted it’s a step towards making transgender more equal, but what next?

“Nothing different happens. They are treated normally like males and females. This (the third gender option) helps, as earlier we struggled to classify their gender,” Rungta said. “The entire process for insurance remains the same, i.e. based on your health condition and financial health.” It’s no different with the private insurance players in the country either.

Premiums on mediclaims though, an amount that is sometimes less for women owing to their higher life expectancy than men, aren’t higher for trans people purely owing to their susceptibility to medical issues. HIV—which, according to the The Joint United Nations Programme on HIV and AIDS (or UNAIDS), affects 7.2% of the Indian trans community as compared to 0.26% in overall population—has no special provision in policies. And in the case of death, the ‘next of kin’ isn’t seen as a big deal by Indian insurers, as according to Rungta, “Jab banda gaya toh uske baad toh medical kharcha hone waala nahi hai (After a person dies, no one has to spend on their medical aid). It doesn’t matter.”

Sometimes trans people who can’t afford the surgery try a different tact. An activist working with a Delhi-based LGBTQ+ organisation, told me that her friend got a hysterectomy (a surgery which removes some or all parts of the uterus) done under their female name. It was covered under insurance, but there was intense surveillance by the hospital because the friend looked like a man.

Now long overdue, some Indian states have started providing government authorised sex reassignment surgeries, with Kerala joining Tamil Nadu in providing Rs 2,00,000 through its social justice department. The state had a trans population of 25,000 people via a 2015 census, but projected that over 80% needed financial aid for the surgery. So they took cognisance. But the rest of post-Section 377 India has a lot of catching up to do.

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