Facts
D., born in 1965, was mandatorily health insured with Konkordia, the Swiss Health and Accident Insurance, until the end of 1996. He had been in psychiatric treatment since October 1989, which was initially covered by Konkordia. From May 1996 onwards, D. applied for the coverage of a weekly one-hour therapy session, which Konkordia only partially approved.
D. filed a complaint against Konkordia's decision, upon which the Social Insurance Court of the Canton of Zurich dismissed the complaint. D. then filed an administrative court appeal with the Federal Insurance Court.
Considerations
The Federal Insurance Court states that delegated medical psychotherapy, i.e., treatment by a non-medical psychotherapist employed by a physician, is also to be recognized as a benefit of the mandatory health insurance under the Federal Health Insurance Act (KVG), provided the necessary requirements are met.
According to Articles 2 and 3 of the Ordinance of the Federal Department of Home Affairs on Benefits in the Mandatory Health Insurance (KLV), a maximum of two sessions per week in the first three years, one session per week in the following three years, and thereafter one session every two weeks are covered by the insurance. A "justified exception" to this rule, allowing for a higher session frequency, is only given according to the case law if special circumstances, as convincingly…