Facts
I., born in 1948, is insured with the health insurance company KPT. She submitted various dental invoices for treatments in the period from January 12, 1996 to April 7, 1997 to the health insurance company. The health insurance company only reimbursed the costs for caries prophylaxis, fluoride splint, and nutritional counseling. I. filed a complaint against this decision.
The Administrative Court of the Canton of Lucerne dismissed the complaint. I. then filed an administrative court appeal with the Federal Supreme Court, requesting a medical expert opinion and the coverage of the dental care costs from January 1996.
Considerations
The Federal Supreme Court states that according to Art. 31 para. 1 lit. b KVG in conjunction with Art. 18 lit. d KLV, the costs for dental treatments that are necessitated by a salivary gland disease or its consequences and are necessary for the treatment of the condition must be covered by the health insurance company.
The decisive factor is whether the dental treatments for the salivary gland disease and the resulting dry mouth with increased susceptibility to caries could have been avoided by sufficient…