Facts
In this case, the appellant, residing in institution Z., requests reimbursement by the insurers for the nursing care provided by the staff of this institution. The Federal Insurance Court considered that these services could not be covered by the mandatory health insurance, insofar as the nursing staff of institution Z. do not practice their activity independently and on their own account, as required by Arts. 46 and 49 of the Health Insurance Ordinance (HIO).Considerations
According to case law, Art. 38 of the Health Insurance Act (HIA) gives the Federal Council a wide margin of discretion to determine the admission conditions for service providers, including persons providing care on medical prescription. The fact that only nurses who meet the conditions of Arts. 46 and 49 HIO are admitted to practice at the expense of mandatory insurance does not violate the law.
Furthermore, the Federal Court cannot go against the clearly expressed will of institution Z. not to participate in the mandatory health…