Facts
The complainant [A.] is insured under the mandatory health insurance with the Agrisano health insurance company (respondent). From December 21-27, 2012, she was hospitalized for emergency treatment at the hospital B. in France. She presented her European Health Insurance Card, which activated the international benefit assistance. The French hospital subsequently demanded from [A.] the deductible of 20% of the hospital costs amounting to 2,395.64 euros, which [A.] paid.
The Joint Institution KVG then claimed the costs of 11,993.40 Swiss francs from Agrisano as the competent health insurer in Switzerland. Agrisano paid this amount. When [A.] requested Agrisano to also reimburse the deductible she had paid, Agrisano refused, as under French law the insured person has to bear 20% of the costs.
Considerations
The Federal Supreme Court confirms Agrisano's rejection to reimburse the deductible paid by A. It states that in case of emergency treatment abroad, which is processed through the international benefit assistance, the Swiss health insurer has no supplementary obligation to cover the deductible charged by the foreign service provider under Art. 36 para. 2 and 4 KVV.
The right to cost sharing in such "classic" benefit assistance cases is determined solely by the applicable foreign legal regulations. An…