Facts
S., born in 1965, has suffered from a sliding hiatal hernia with reflux oesophagitis since childhood. Due to the damage to the tooth enamel caused by the gastric reflux, she had to undergo costly dental treatment from March 1996 onwards. The SWICA Gesundheitsorganisation refused to cover these costs, considering that it was not a mandatory benefit. The Insurance Court of the Canton of St. Gallen dismissed S.'s appeal against this decision. S. then filed an administrative law appeal with the Federal Insurance Court.Considerations
The Federal Insurance Court considers that the list of conditions requiring dental care to be covered by insurance, as established in the Ordinance on Health Insurance Benefits (HIBO), is exhaustive. The sliding hiatal hernia with reflux oesophagitis suffered by the appellant is not included in this list. Although this disease can lead to significant dental damage, it cannot be equated with the serious illnesses mentioned in the HIBO that entitle the insured to have their dental costs covered by the mandatory health insurance.
The Federal Court notes that the legislator, during the revision of the Health Insurance Act, wanted to strictly limit the coverage of dental care by the basic insurance, departing from the previous regulation which was…