Facts
Dr. S., a Swiss citizen and pensioner of the Council of Europe in Strasbourg, applied for an exemption from the compulsory health insurance in Switzerland, claiming that he was still insured with insurer V. of the Council of Europe. The Health Insurance Office of the Canton of Ticino (UAM) rejected the application, considering that the foreign insurance coverage was not equivalent to that provided by Swiss law. After a referral by the Federal Tribunal to further examine the issue of equivalence, the UAM confirmed its rejection. The Cantonal Tribunal and subsequently the Federal Tribunal dismissed Dr. S.'s appeal.
Considerations
The Federal Tribunal considered that the insurance coverage offered by the insurer of the Council of Europe was not equivalent to that provided by Swiss law, as it had significant gaps, such as maximum reimbursement limits for certain benefits and lack of coverage for all treatments recognized in Switzerland. Therefore, Dr. S. could not be exempted from the compulsory insurance in Switzerland under Art. 6 para. 3 of the Ordinance on Health Insurance (OAMal).
The Federal Tribunal also excluded the applicability of Art. 2 para. 2 of the OAMal, as Dr. S. was not compulsorily insured abroad based on the law of a state with which there…