Decision on the end of the suspension of coverage of benefits in the event of late payment of premiums

Facts

SWICA Krankenversicherung AG appealed against a decision of the Insurance Court of the Canton of St. Gallen concerning the coverage of N.'s hospitalization costs. The cantonal court ruled that the suspension of coverage of benefits decided by the insurance fund on 15 December 1999 was no longer justified following the payment made by the municipality of X. in January 2000. SWICA then appealed to the Federal Supreme Court, which had to determine whether this cantonal decision was in accordance with federal law.

Considerations

The Federal Supreme Court considered that, according to the interpretation of Art. 9 para. 2 of the Health Insurance Ordinance (HIO) in its version applicable until 31 December 2002, the suspension of coverage of benefits ends when the premiums (including ancillary costs) that were the subject of the certificate of loss of assets leading to the notification to the social assistance authority and the suspension of benefits are paid. The fact that other outstanding premiums may exist is not sufficient to maintain the suspension.

The Federal Supreme Court thus ruled that the cantonal court had not violated federal law in considering that the suspension of coverage of benefits decided on 15 December 1999 could no longer be maintained following…