Reimbursement of Paediatric Home Care Services by Health Insurance

Facts

The appellant [V.] , born in 2007, suffers from a congenital defect (brain tumour). The Disability Insurance granted her benefits such as helplessness allowance and intensive care supplement. The Paediatric Home Care Service of Canton [X.] (Kispex) provided care services for [V.] between January and September 2009, the costs of which amounting to a total of CHF 20,427.50 were rejected for reimbursement by the health insurance KLuG. The Federal Supreme Court dismissed the appeal of [V.] against the negative decision of the Administrative Court of the Canton of Schwyz and referred the matter back to the lower instance for re-assessment.

Considerations

The Federal Supreme Court decided that the services provided by Kispex are to be qualified as nursing care within the meaning of Art. 7 para. 2 lit. b HIBO. Since nursing care services are not congruent with the helplessness allowance and the intensive care supplement, their inclusion in the over-compensation calculation is excluded. The appellant is therefore entitled to the full reimbursement of the costs for the nursing care in the total amount of CHF 20,427.50 for the months of January to September 2009.

With regard to any potential loss of earnings of the appellant's…