Facts
The Public Health Insurance Fund of Basel (ÖKK) invoiced the insured person B. a deductible of 321.30 francs for her hospitalization from September 15 to 23, 1996 due to complications that occurred during her pregnancy (vaginal bleeding and premature cervical maturation). The Insurance Court of the Canton of Basel-Stadt upheld the insured person's appeal, considering that benefits related to pregnancy, including in case of complications, are exempt from any cost-sharing. The ÖKK filed an administrative law appeal against this decision.Considerations
According to the case law prior to the entry into force of the HIA, only normal pregnancy was exempt from cost-sharing, while complications that occurred during pregnancy were considered cases of illness requiring the insured person's participation. The DFC considers that this distinction is still justified, as it is compatible with the spirit and purpose of the regulation providing for the exemption from cost-sharing in case of maternity. Indeed, benefits related to normal pregnancy are intended to protect the family, which does not apply solely to uncomplicated pregnancies.
Ther…