Jurisprudential rules in prepaid medicine clauses for transgender people

Abstract

This article analyzes how the inclusion of contractual aesthetic exclusion clauses in prepaid medicine contracts in Colombia can operate as a tool for systemic discrimination against transgender people. Using a qualitative legal-doctrinal methodology, a case study of Ruling T-377 of 2025 is conducted, which addresses the refusal of Colmédica (prepaid medicine) to authorize gender-affirmation procedures such as mammoplasty and facial feminization for a transgender woman, invoking an aesthetic exclusion clause. The Court determined that such procedures are not aesthetic when they seek to reaffirm gender identity, ordered their coverage, and established eight jurisprudential rules on the right to health, diagnosis, and comprehensiveness for transgender people. This is complemented by a critical review of the case law and regulatory framework. It is argued that, although the case consolidates progress in the recognition of rights and imposes obligations on EPSs, the Court did not mandate structural safeguards that prevent discrimination from the outset without the need for litigation.