In its decision of 10 April 2024, the Federal Supreme Court rejected the appeal filed by individual A. against the refusal of Sanitas Grundversicherungen AG (Sanitas) to cover the costs of facial feminization surgery.

A. is undergoing a male-to-female transition. A. sought this procedure to align her physical appearance with her gender identity. Sanitas had refused to pay for the operation and the Social Insurance Court of the Canton of Zurich had upheld Sanitas' decision, ruling that facial feminisation surgery isn't covered by compulsory health insurance.

The court shared this opinion and held that transgender identity alone doesn't necessitate treatment due to medically significant consequences. In addition, it found that the facial appearance didn't clearly correspond to typical male characteristics. The court based its decision on the principle that purely aesthetic procedures without medically significant effects are not covered by the provisions of Art. 3 para. 1 of the Federal Act on the General Aspects of Social Security Law (Bundesgesetz über den Allgemeinen Teil des Sozialversicherungsrechts, ATSG) and Art. 24-31 and 32-34 of the Federal Law on Health Insurance (Bundesgesetz über die Krankenversicherung, KVG). Established case law on the obligation of health insurers to cover medical expenses supported this position. A.'s appeal was therefore rejected.

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