Decision on the Approval of Premium Tariffs for Compulsory Health Insurance

Facts

CSS Kranken-Versicherung AG and A. AG submitted applications to the Federal Office of Public Health (FOPH) for the approval of their 2007 premium tariffs for compulsory health insurance (OKP). The FOPH did not fully approve the tariffs, as the order of premium reductions according to Art. 90b of the Health Insurance Ordinance (KVV) was not observed. The insurers then filed a complaint with the Federal Administrative Court, which was dismissed. They subsequently filed an appeal in public law matters with the Federal Supreme Court.

Considerations

The Federal Supreme Court concluded that the order of premium reductions according to Art. 90b KVV is irrelevant for the outcome. The decisive factor is that the premium reduction for the restricted choice of service providers according to Art. 101 para. 3 KVV must be calculated as a percentage of the premium for the ordinary insurance and not of the premium already reduced by the deductible discount. The FOPH's approach of calculating the premium reduction for the restricted choice of service providers as a percentage of the already reduced premium violates Art. 101 para. 3 KVV.