Facts
[K.], born in 1922, was insured with the Helvetia health insurance fund. During two hospitalizations in the private ward, in October 1996 and February 1997, the insurer reimbursed the daily allowance applicable to patients over 62/65 years of age, i.e. 310 francs, whereas the allowance for younger patients was 349 francs. [K.] contested this difference in reimbursement before the Administrative Court of the Canton of Geneva, which dismissed her appeal. [K.] then appealed to the Federal Insurance Court.Considerations
The Federal Insurance Court ruled that the appeal was admissible, as it did not concern the establishment or approval of the tariff as such, but its application in a specific case. However, it dismissed the appeal on the merits.
According to the Court, the difference in the daily allowance based on age is not contrary to the law nor constitutive of a prohibited inequality of treatment. The health partners have a great deal of freedom to set the tariffs, with the aim of controlling costs while ensuring a high-quality healthcare offering. The tariff distinction is probably based on statistical data showing that hospital costs vary according to age groups, which justifies a…