Health Insurance for Transgender Persons


    In News

    • Recently, the Union government said that the Transgender persons will get yearly health insurance of Rs 5 lakh each under the Ayushman Bharat scheme.

    About the recent decision taken 

    • Data:
      • There are 4.8 lakh transgender persons in India who will be eligible for benefits under the scheme. 
    • Memorandum of understanding
      • The National Health Authority under the Health Ministry signed a memorandum of understanding on this scheme with the Social Justice Ministry. 
    • Coverage:
      • The insurance policy will also cover sex reassignment surgeries.
        • More hospitals will be empaneled to provide sex reassignment surgeries. Provisions were being made to offer services at AIIMS and other hospitals.
      • Health cards issued to Transgender persons will not cover their family members.  
      • Benefits will be extended to those holding a transgender certificate issued by the national portal for transgender persons.
      • The scheme will cover all transgender persons not receiving such benefits from other centre/state sponsored schemes. 
    • Change in Definition
      • The government has changed the definition of the family to provide the total yearly coverage to transgender persons.
    • Major Issues surrounding this decision 
      • Misleading figures: The 4.8 lakh figure is as per the 2011 census and only 2 percent of this number has been issued the certificate by the Social Justice Ministry so far. 
      • Few trained surgeons: Even if others are able to get their cards, the challenge is that sex reassignment surgeries are not offered by many institutions, and there are very few trained plastic surgeons in the country. 

    Challenges faced by Transgender Community:

    • Discrimination and ostracisation:
      • They face discrimination in employment, educational institutes, and within families which severely affects their overall wellbeing.
    • Identity crisis:
      • They are often forced to identify with a gender with which they are not associated at the workplace despite the government passing the Transgender Persons (Protection of Rights) Act, 2019 which allows the community the right to self-perceived gender identity.
    • Social Stigma:
      • They often face difficulty in property inheritance or child adoption. Because of being socially ostracised, they are compelled to take up menial jobs despite good qualifications or forced into sex work.
    • Unemployment:
      • The community has limited avenues of employment and faces severe discrimination at work because of the associated social stigma.
    • Lack of public amenities:
      • They face issues with the accessibility of public toilets and public spaces. They often face problems in prisons, hospitals and schools.

    Initiatives for Transgender Persons in India:

    • Transgender Persons (Protection of Rights) Act, 2019:
      • The law passed by the Parliament aims to end discrimination against transgender persons in accessing education, employment and healthcare and recognise the right to self-perceived gender identity.
    • Transgender Persons (Protection of Rights) Rules, 2020: 
      • It has been framed by the government to give effect to the provisions of the Transgender Persons (Protection of Rights) Act, 2019.
    • National Council for Transgender Persons: 
      • In pursuance of the Transgender Persons (Protection of Rights) Act, 2019, the National Council for Transgender Persons has been constituted to advise the Central Government on the formulation and evaluation of policies, programmes, legislation and projects for the welfare of the transgender community.
    • Reservation for the transgender community: 
      • The Union government is planning to bring reservations for the community under the OBC category in employment.
    • National Portal for Transgender Persons:
      • It is a portal by the Ministry of Social Justice and Empowerment which assists persons of the transgender community in applying for a Certificate and Identity card digitally from anywhere in the country.
      • Through the Portal, they can monitor the status of their application which ensures transparency in the process.
    • Garima Greh:
      • The scheme aims to provide shelter to Transgender persons, with basic amenities like shelter, food, medical care and recreational facilities.
      • Besides, it will provide support for the capacity-building/skill development of persons in the Community, which will enable them to lead a life of dignity and respect.

    Way Forward

    • Several steps have been taken by the government to implement a package of five assurances: Education, Life with dignity, Health support, Opportunities for livelihood and Skill Enhancement.
    • Dignified life and livelihood: These steps have been taken to ensure that marginalized and disadvantaged sections of the population can emerge from restrictive social constructs by providing them dignified life and livelihood.
    • Effective functioning: Though the state along with civil society must ensure the effective functioning of the council with respect to identifying the challenges faced by the community and redressing it.
    • Social engineering: There is a need to sensitise the society that the community is a part of us and are co-equals.
    • Sensitising the law enforcement: There is also a need to sensitise the legal and law enforcement systems towards the challenges of the community. 

    Ayushman Bharat PMJAY

    • It was launched in 2018.
    • PMJAY is a centrally sponsored scheme.
      • It is entirely funded by the Government and the funding is shared between Centre and State governments as per prevailing guidelines of the Ministry of Finance.
    • PMJAY provides cashless and paperless access to services for the beneficiary at the point of service in any (both public and private) empanelled hospitals across India.
      • A beneficiary from one State can avail benefits from an empanelled Hospital anywhere in the country.

    Sex Reassignment Surgery 

    • It is also known as gender reassignment surgery, gender confirmation surgery.
    • It is a surgical procedure by which a transgender person’s physical appearance and function of their existing sexual characteristics are altered to resemble those socially associated with their identified gender.
    • It is part of a treatment for gender dysphoria in transgender people. 
      • The term is also sometimes used to describe surgical intervention for intersex people.
    • These surgeries include vaginoplasty, feminizing augmentation mammoplasty, orchiectomy, facial feminization surgery, reduction thyroid chondroplasty (tracheal shave), and voice feminization surgery among others. 


    Transgender Persons (Protection of Rights) Act, 2019 

    Salient provision of the Act:

    • Defines transgender person:
      • The Bill defines a transgender person as one whose gender does not match the gender assigned at birth.  It includes trans-men and trans-women, persons with intersex variations, gender-queers, and persons with socio-cultural identities, such as kinnar and hijra. 
      • Intersex variations are defined to mean a person who at birth shows variation in his or her primary sexual characteristics, external genitalia, chromosomes, or hormones from the normative standard of male or female body.
    • Prohibition against discrimination: The Bill prohibits the discrimination against a transgender person, including denial of service or unfair treatment in relation to:
      • Education
      • Employment
      • Healthcare
      • Access to or enjoyment of goods, facilities, opportunities available to the public
      • Right to movement
      • Right to reside, rent, or otherwise occupy property
      • Opportunity to hold public or private office
      • Access to a government or private establishment in whose care or custody a transgender person is
    •  Right of residence: 
      • Every transgender person shall have a right to reside and be included in his household.  
      • If the immediate family is unable to care for the transgender person, the person may be placed in a rehabilitation centre, on the orders of a competent court.
    • Employment: 
      • No government or private entity can discriminate against a transgender person in employment matters, including recruitment, and promotion. 
      • Every establishment is required to designate a person to be a complaint officer to deal with complaints in relation to the Act.
    • Education: 
      • Educational institutions funded or recognised by the relevant government shall provide inclusive education, sports and recreational facilities for transgender persons, without discrimination.
    • Health care: 
      • The government must take steps to provide health facilities to transgender persons including separate HIV surveillance centres, and sex reassignment surgeries.  
      • The government shall review medical curriculum to address health issues of transgender persons, and provide comprehensive medical insurance schemes for them.
    • Certificate of identity for a transgender person: 
      • A transgender person may make an application to the District Magistrate for a certificate of identity, indicating the gender as ‘transgender’.  
      • A revised certificate may be obtained only if the individual undergoes surgery to change their gender either as a male or a female.
    • Welfare measures by the government:
      • The Bill states that the relevant government will take measures to ensure the full inclusion and participation of transgender persons in society. 
      • It must also take steps for their rescue and rehabilitation, vocational training and self-employment, create schemes that are transgender sensitive, and promote their participation in cultural activities.
    • Offences and penalties: The Bill recognize the following offences against transgender persons:
      • Forced or bonded labour (excluding compulsory government service for public purposes)
      • Denial of use of public places
      • Removal from household and village
      • Physical, sexual, verbal, emotional or economic abuse. 
      • Penalties for these offences vary between six months and two years, and a fine.
    • National Council for Transgender persons: The Act provides for National Council for Transgender persons (NCT). The NCT will consist of: 
      • Union Minister for Social Justice (Chairperson)
      • Minister of State for Social Justice (Vice- Chairperson)
      • Secretary of the Ministry of Social Justice
      • One representative from ministries including Health, Home Affairs, and Human Resources Development. 
      • Other members include representatives of the NITI Aayog, and the National Human Rights Commission. 
      • State governments will also be represented.  The Council will also consist of five members from the transgender community and five experts from non-governmental organisations.

    Source: IE