Facts
M. (born 1989) is insured with Panorama Health and Accident Insurance. Due to a diagnosed tension in the area of the chewing muscles and associated headaches, she was treated with a Michigan splint at Clinic Y. in 2008. However, Panorama Health and Accident Insurance rejected the coverage of the costs for the Michigan splint in the amount of CHF 563.20, as it was of the opinion that this was not a mandatory benefit of the mandatory health insurance.
M. filed a complaint against the rejecting objection decision. The Social Insurance Court of the Canton of Basel-Stadt upheld the complaint and obliged Panorama Health and Accident Insurance to cover the costs for the treatment with the Michigan splint. Thereupon, Panorama Health and Accident Insurance filed a public law appeal with the Federal Supreme Court.
Considerations
The Federal Supreme Court concluded that the Michigan splint is to be classified as a means and object within the meaning of Art. 25 para. 2 lit. b KVG and is therefore generally subject to the list obligation according to Art. 20a para. 1 KLV. However, since the Michigan splint is not listed as a separate product in the list of means and objects (MiGeL) nor can it be assigned to any of the product groups mentioned there, there is no obligation for the mandatory health insurance to cover the costs of the splint.
The Federal Supreme Court also examined whether the Michigan splint could exceptionally be exempt from the list obligation according to Art. 20a para. 2 KLV. However, it came to…