
The court found that the penile-sparing vaginoplasty qualifies as an insured service and must be covered under the Ontario Health Insurance Plan (OHIP).
In its decision, the court found that the penile-sparing vaginoplasty qualifies as an insured service and must be covered under the Ontario Health Insurance Plan (OHIP). The case involved a biologically male individual identified in court records as K.S., who does not exclusively identify as either male or female and sought to maintain both genitalia. This marks the third unanimous ruling in favor of K.S., according to a report by the National Post.
“K.S. is pleased with the Court of Appeal’s decision, which is now the third unanimous ruling confirming that her gender affirming surgery is covered under Ontario’s Health Insurance Act and its regulation,” K.S.’s lawyer said in an email to the National Post.
The situation began in 2022 when K.S.'s request to have OHIP fund the surgery was denied. The procedure, available at a Texas clinic but not in Canada, would involve creating a vagina while preserving the penis. OHIP argued the surgery did not fit within its Schedule of Benefits because it did not involve a penectomy and should therefore not be publicly funded. The agency also argued that the surgery was experimental and ineligible for coverage.
Following the rejection by OHIP, K.S. appealed to the Health Services Appeal and Review Board, which overturned OHIP’s decision. OHIP then appealed to the Divisional Court and lost again. Now, the province’s top court has once more ruled against OHIP.
The court noted that K.S., who uses female pronouns, “experienced significant gender dysphoria since her teenage years, as well as physical, mental and economic hardships to transition her gender expression to align with her gender identity.”
Ontario has until June 23 to seek leave to appeal the decision to the Supreme Court of Canada.
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