Late affiliation to compulsory health insurance and competence for the collection of a premium supplement

Facts

H., a Swiss citizen born in 1974, was compulsorily insured against illness with the CPT health insurance fund from January 1, 2000. On September 4, 2000, he applied to the Health Insurance Office of the Canton of Ticino (UAM) for a premium subsidy for 2001. The UAM identified a late affiliation to compulsory health insurance and, by decision of October 26, 2000, determined that the theoretical beginning of the insured person's insurance obligation was January 1, 1996. As the insurance delay was not justifiable, the UAM ordered that a premium supplement was to be collected, to be determined based on the insured person's financial situation.

H. appealed to the Insurance Court of the Canton of Ticino, requesting the annulment of the actual affiliation to the CPT with effect from January 1, 2000 and the theoretical one from January 1, 1996, as well as the referral of the file to the administrative authority for the examination of the requirements for exemption from the insurance obligation. The cantonal court dismissed the appeal.

H. then filed an administrative law appeal to the Federal Court, requesting the annulment of the decisions of the UAM and the cantonal court, as well as the determination of the exemption from the insurance obligation from January 1, 1996 to December 31, 1999 and/or the lack of fault in relation to the possible late affiliation.

Considerations

The Federal Court partially upheld the appeal. It considered that the UAM and the cantonal court were not competent to rule on the ex officio affiliation of the person concerned to the CPT health insurance fund with effect from January 1, 2000, nor on the obligation to pay a premium supplement in the event of late affiliation. These competences belong exclusively to the health insurer.

Regardi…