Coverage of the costs of medical treatments performed abroad

Facts

S. is insured with the health insurance company Assura. Following a diagnosis of sarcoma, her physician referred her to the Institute X. in Milan for a surgical intervention. Assura refused to reimburse the costs of this treatment performed abroad, on the grounds that it was not emergency care and that there were no provisions determining the treatments provided abroad that insurers had to cover.

S. appealed this decision to the Administrative Court of the Canton of Neuchâtel, which upheld the appeal. Assura then filed an administrative law appeal against this judgment.

Considerations

According to the Federal Supreme Court, Art. 34 para. 2 of the Federal Health Insurance Act (LAMal) gives the Federal Council the simple power, and not the obligation, to decide on the coverage of the costs of treatments performed abroad. The text of the law, the preparatory work, and the system of health insurance do not allow for the deduction of a subjective right to the benefit.

However, the Federal Supreme Court considers…