Health Insurance and Gender-Affirming Care in the Netherlands

In the Netherlands, many aspects of transgender healthcare are covered by basic health insurance, provided the care is medically necessary and the relevant conditions are met.

Basic health insurance

In the Netherlands, many aspects of transgender healthcare are covered by basic health insurance, provided the care is medically necessary and the relevant conditions are met. This includes intake and diagnostic assessment at a recognised gender clinic, hormone therapy, hair removal in the surgical area, gender-affirming surgery and — where medically indicated — fertility preservation.

Deductible and personal contributions

For most healthcare, the statutory deductible applies. Some care, such as voice training outside a speech therapy practice or cosmetic corrections without a medical indication, is not covered by basic health insurance.

Waiting times and referrals

Access to reimbursed care is through a general practitioner and a recognised gender centre. Waiting times at Dutch gender clinics have been long for years.

What is and is not covered

Basic health insurance covers care that meets the standards of scientific evidence and professional practice and that a person can reasonably be considered to need. For gender-affirming care, this means psychological assessment, puberty blockers and hormones, genital surgery and chest masculinisation surgery for transgender men. Treatments considered cosmetic are excluded. In most cases, this concerns facial surgery and, for a long time, also breast augmentation for transgender women, for which the government has introduced a separate subsidy scheme. Supplementary insurance sometimes covers part of the cost of hair removal or speech therapy. Information on how coverage differs between health insurers is available at trans-nederland.nl, in the overview of what health insurers reimburse.

Costs for the insured person

For care covered by basic health insurance, adults pay the statutory deductible. There is no deductible for young people under eighteen. Anyone who travels abroad for surgery will generally receive, under a benefits-in-kind policy, reimbursement of part of what the treatment would have cost in the Netherlands and must obtain prior approval from the insurer. Hormones purchased online without a prescription are not reimbursed and are outside medical supervision.

Reimbursement and evidence

The criterion of scientific evidence and professional practice plays a distinct role in the debate. The National Health Care Institute assesses, on the basis of this criterion, whether a treatment belongs in the basic health insurance package. In countries where the evidence for puberty blockers and hormones for young people has been independently assessed, the conclusion was that the evidence is weak; see systematic reviews in gender-affirming care. In the Netherlands, reimbursement for these treatments for young people has not changed. You can read more about waiting times at waiting times and the healthcare system. Reimbursement for care after reversing a transition is not explicitly regulated in the Netherlands; see medical costs of detransition.