Facts
The case concerns the admissibility of private insurance-related subsidies from a parent company (holding) to its subsidiaries operating in the field of social health insurance. The Federal Office of Public Health (FOPH) had classified the subsidies of CHF 79.9 million from CSS Holding AG to its subsidiaries Sanagate AG, CSS Kranken-Versicherung AG and Arcosana AG as violations of the Federal Health Insurance Act (KVG) and ordered their repayment.
The subsidiaries (appellants) subsequently filed a complaint with the Federal Supreme Court. They argued that the subsidies from the parent company were permissible to strengthen their reserves and thus avoid one-time surcharges on premiums within the framework of premium adjustments under Art. 106a KVG.
Considerations
The Federal Supreme Court dismissed the appeal. It stated that the financing of mandatory health insurance under the KVG is conclusively regulated and does not provide for any possibility of additional sources of financing such as subsidies from the parent company. Health insurers are bound by the special legal regulations of the KVG with regard to the financing of their services, which do not provide for and therefore prohibit the accumulation of reserves through subsidies from the parent company.
The court made it clear that corporate structures such as a holding company must not circumvent the applicable financing procedure and the limited financial autonomy of health insurers. Cross-subsidization of social health insurance by funds…