On this page you’ll find some handy information special for transgender asylum seekers and refugees, but also for other foreigners, about the health care situation in the Netherlands in general, for transgender people, for asylum seekers in general and for transgender asylum seekers. Followed bij information on activities by Transvisie for trangender asylum seekers and refugees, and activities by other organisations.
Patient organisation Transvisie, Transgender Netwerk Nederland (TNN), COC and some single volunteers set up the Koploperoverleg Transgender Vluchtelingen. This consultative body shares knowledge and experiences and undertakes action to improve the situation of transgender refugees. If you are in search of more information than the health care information on this page, please refer to the English webpage of the Koploperoverleg for more general information.
Are you, or do you know, a transgender refugee in an asylum seeker center that has been discriminated, threatened or otherwise had to deal with violent or unsafe circumstances? Haven’t you received the proper healthcare at one of these centers? Or are you housed in an area, village or city where you know nobody and feel unsafe? You can contact the hotline that TNN and COC (two partners of Transvisie) have launched to report this.
Health care in the Netherlands in general
- In the Netherlands there is a wide availability of GP’s, therapists, hospitals, health practitioners and dentists offering all sorts of care.
- Everybody form 18 years and elder, living in the Netherlands is obliged to have a health insurance, but there are different ruls for different groups.
- Health insurance is semi-commercial in the Netherlands. It is mandatory with an ‘eigen risico’ (a limited, but fairly big amount (in 2017: €385 a year) to pay for yourself) and one or more mandatory contributions. The ‘eigen risico’ doesn’t apply to GP health care.
- The baseline health insurance is defined by our government (‘basisverzekering’). It covers GP, hospital care, psychological care and some other health practitioners (partly). Dental care is not covered. All health insurance companies offer this ‘basisverzekering’, rates and conditions vary.
- On top of that, health insurance companies offer extra insurance modules (‘aanvullende verzekeringen’) to cover all kinds of other health costs like dentists, extra sessions with a physiotherapist, etc.
- To get a health insurance, you need a bank account and a BSN (social security number). To get a BSN you need a refugee-permit (‘status’). For asylum seekers still in procedure, there are special health provisions (read ahead).
- For a proper health insurance, please don’t take a “budget polis“! You need a so called “restitutiepolis” ! in order to have all, anyway most, of your expenses covered.
- If you work in the Netherlands or when you study over here and you don’t have a sufficient income you can get “zorgtoeslag” from our tax organisation (Belastingdienst).
- Students from another EU/EER country, who are insured in the country of origin, need to contact CZ Zorgverzekeringen (046 4595812).
- Students not from a EU/EER country can temperorly insure themselves through a Schengen Visitors assurance by Oom-verzkeringen. See the website.
- Students who are als working in the Netherlands need a Dutch health insurance.
Transgender health care in the Netherlands
- The transgender health care is mainly limited to VUmc in Amsterdam and UMCG in Groningen. Psychological transgender care is more widespread (in 2017: PsyQ, Psycho Informa Instellingen, De Vaart, Stepwork, Genderteam Zuid Nederland and others). Only a few independent endocrinologists work outside the VUmc and UMCG.
- The VUmc and UMCG offer psychology, hormone treatment and surgery. Both hospitals have long waiting lists. Not only for the first psychological session, but also before hormone treatment and before surgery.
- Hormone treatment for MtF is based on estradiol (oestrogen) and a testosterone-suppressant.
- Hormone treatment for FtM is based on testosterone (injectable or gel). Take care not all sorts of testosteron are coverd by the ‘Basisverzekering’ (ask for information about this at te hospital).
- If you have a Dutch health insurance, treatment is fully covered. There are some limitations though. Be sure getting the right information on this subject. The ‘Basisverzekering’ covers psychological help, hormone treatment (both the hormones itself as the monitoring by the doctor) and the SRS (surgary) (see also our page (in Dutch) ‘Zorgverzekering‘.
- You need approval from the genderteam VUmc or UMCG and their psychologist before surgary is being performed.
- For FtM the health insurance also covers facial hair removal (limited) and facial surgery (under strict conditions). Breast enhancement is not covered.
- For MtF the health insurance also covers mastectomy and hysterectomy.
- If you are diagnosed as ‘genderdysfor’ in your country of origin, the posibility exsists that the VUmc or UMCG takes over this diagnosis.
- If possible take as much possible information from psychologists, docters etc. with you in Enlish from your country of origin.
- If possible take sufficient hormone medication or a prescription with you to cover at least 1 1/2 year.
Health care for asylum seekers
- As long as you are still in procedure, you cannot get regular health insurance.
- There is a special health insurance for asylum seekers. It is defined by our government and described in the RZA (‘Regeling Zorg Asielzoekers’). https://rzasielzoekers.nl/dynamic/media/28/documents/RZA_regeling_2017.pdf (in Dutch!).
- In section 11.20 (Medisch specialistische zorg) and more specific: on page 33, it states that it covers psychological support for transgender persons as well as hormone treatment (as long as you already had this treatment in your country of origin). Starting you hormone treatment is not covered in the RZA. Neither is surgery.
- This insurance is provided by the Menzis COA Administratie (MCA) in 2017. From 2018 it will be DSW assurance.
- For GP health care there are special doctors at or near the AZC: GCA doctors in 2017. From 2018 it will be Arts&Zorg.
- There is no ‘eigen risico’ and no contribution at the RZA.
Current issues in transgender health care for asylum seekers
- Only very few GP’s at the AZC’s have specific knowledge of transgender issues. Of course they have some basic knowledge but not enough for treatment. They mostly don’t know that some transgender health care is covered by the RZA insurance.
- GP’s at the AZC experience limited access to colleagues at the VUmc or UMCG to help them offer care.
- Since there are almost no independent endocrinologists available outside the VUmc and UMCG, GP’s from the AZC have limited options for referral.
- VUmc and UMCG have an unclear policy about quick entry for asylum seekers who were diagnosed as genderdysfore and who had already hormone treatment in their country of origin.
- It really depends on the individual GP what they can achieve for you.
- Our organisation tries to solve these issues by advocacy and deliberation with COA, government, health carers and insurance company.
Activities by Transvisie for transgender refugees
Transgender refugees can meet other trangenders at the peer groups from Transvisie. Transvisie has al lot of peer groups all over the country. See our page ‘lotgenoten‘ One of our peer groups is ‘Trans United’ a group in Amsterdam special for transgenders with another cultural background.
If you would like to have direct contact with one of our employees, you can also apply for them to visit you at the asylum centre. You can e-mail email@example.com