Facts
Werner [W.], born in 1965, had been insured with the Swiss Trade Union Health Insurance Fund (GKK) since birth. After moving out of his parents' home, he stopped paying contributions. The GKK then issued a decision to collect the contributions, initiated debt collection proceedings, and ultimately marked the membership card with the note "Departure as of 1.12.85". Later, the insured's father applied for the reactivation of the insurance, whereupon the GKK readmitted Werner [W.] under reservation as of July 1, 1989.
Subsequently, the father filed a complaint against the GKK's decision, which was upheld by the Cantonal Insurance Court of Zurich, and the decision was overturned. Thereupon, the GKK filed an administrative court appeal, requesting that the insured's membership be considered lapsed and his readmission under reservation be deemed justified.
Considerations
The Federal Insurance Court confirmed the decision of the Cantonal Court. It stated that the GKK had not properly carried out the exclusion of the insured due to arrears in contributions. The mere threat of exclusion in the decision of August 12, 1985 does not meet the requirements of the case law. Furthermore, the GKK had not proven that it had taken the necessary precautions in the event of the insured's inaccessibility.
The assumption of a tacit or implied withdrawal of the insured also fails. The statutes of the GKK provide for a written declaration of withdrawal, which did not occur here. Even if this were not seen as a requirement for validity, the circumstances did not allow…