Decision on the coverage of contact lenses by disability insurance

Facts

This decision concerns an appeal filed by B. against the decision of the AI Office of Bern and the Administrative Court of the Canton of Bern. The dispute concerns the coverage by disability insurance of the costs of contact lenses in cases of severe keratoconus or very pronounced irregular astigmatism.

According to Art. 21 para. 1 InvIA, the insured person is entitled to the auxiliary means listed in a list established by the Federal Council, insofar as they are needed to pursue a gainful activity or an activity in their field of tasks, for their training, education or functional adaptation. The costs of dental prostheses, glasses and orthopedic insoles are only covered if these auxiliary means constitute an important complement to medical integration measures.

Until February 29, 1996, item 7.02* of the Annex to the InvIAO provided for an autonomous right to contact lenses in cases of severe keratoconus or very pronounced irregular astigmatism, regardless of whether they constituted an important complement to medical integration measures. This regulation was amended as of March 1, 1996, eliminating this autonomous right. Since then, the reimbursement of contact lenses by disability insurance is only possible if they constitute an important complement to medical integration measures, including in cases of severe keratoconus or very pronounced irregular astigmatism.

Considerations

The Federal Tribunal examines the legality of this regulatory amendment. It considers that Art. 21 para. 1 InvIA confers on the Federal Council, or the competent Federal Department, a wide margin of discretion to define the list of auxiliary means covered by disability insurance. The Department is not required to include in this list all the auxiliary means that a disabled person needs for their integration, but may make a selection and limit their number, while respecting the principle of the prohibition of arbitrariness.

Contrary to the appellant's argument, Art. 21 para. 1 sentence 2 InvIA does not have the effect of restricting this regulatory discretion, by imposing the additional condition that the coverage of dental prostheses, glasses and orthopedic insoles must constitute…