Facts
D. is a member of Konkordia, a Swiss health and accident insurance provider. Under the previous Health Insurance Act (KUVG), Konkordia's insured members had the option to cover the costs not covered by the standard benefits of the basic insurance by paying an additional premium for private patient insurance (PPV).
With the entry into force of the new Federal Health Insurance Act (KVG) on January 1, 1996, Konkordia abolished the PPV and instead offered the supplementary insurance "DIVERSA plus". However, this supplementary insurance only covers the costs of physicians who have refused to provide their services according to the tariff of the mandatory health insurance (non-participating physicians), up to 75% or a maximum of 2,000 Swiss francs per year.
D. argues that this change no longer guarantees the previous scope of insurance coverage and violates the transitional guarantee of coverage under Article 102(2), sentence 3 of the KVG. She therefore filed a lawsuit against Konkordia, demanding that the insurer offer her an insurance contract that provides at least the same scope of coverage as before, including the former private patient supplements.
Considerations
The Federal Supreme Court dismisses the appeal and confirms the contested judgment. It states that according to the transitional guarantee of coverage under Article 102(2), sentence 3 of the KVG, insurers must provide their insured members at least the previous scope of insurance coverage. However, this guarantee only covers provisions of the health insurers regarding benefits that go beyond the scope of benefits under Article 34(1) of the KVG.
In the present case, the question was whether Konkordia was obligated under transitional law to offer the plaintiff a supplementary insurance that, like under the KUVG, would cover…