Facts
The case concerns the question of whether the disability insurance is obliged to cover the costs of a hearing aid whose price exceeds the maximum amounts specified in the tariff agreement. The insured person was entitled to a digital hearing aid, for which the IV-Stelle (Disability Insurance Office) granted a cost contribution of CHF 4,918.15 (incl. VAT). The appellant claimed that due to her particular disability-related situation, a more expensive hearing aid was necessary.
Considerations
The Federal Court notes that the tariff agreement for the supply of hearing aids concluded by the Federal Office of Social Insurance (BSV) is generally in compliance with federal law. However, the maximum amounts specified therein for the reimbursement of services do not constitute a legally effective restriction of the social insurance entitlement to benefits. Rather, it must be examined in each individual case whether the tariff agreement rates are sufficient to meet the insured person's disability-related integration needs.
The court emphasizes that the insured person is not entitled to the best possible measures, but as a rule only to the necessary and appropriate measures for integration. Therefore, the tariff provisions must be designed in such a way that their application ensures a hearing aid supply that, while only simple and practical, nevertheless achieves the goal of adequate communication.
However, the judicial review remains reserved as to whether the maximum prices…