Rejection of Coverage for Non-Medical Psychotherapy Costs by Mandatory Health Insurance

Facts

The dispute concerns the question of whether the appellant's psychotherapeutic treatments should be covered by mandatory health insurance, both under the former law (HIA) and the new law (HIA) that entered into force on 1 January 1996. The appellant, insured with Visana Health Insurance, underwent psychological therapy with an independent psychologist, Dr. phil. S., between May 1995 and September 1996. The health insurance fund refused to cover the costs of these treatments, on the grounds that non-medical psychotherapy is not a mandatory benefit of health insurance.

Considerations

According to the case law of the Federal Insurance Court, under the former law (HIA), only "delegated psychotherapy" performed by a psychologist or non-medical psychotherapist employed by a physician and under their supervision and responsibility was considered a mandatory benefit of health insurance. In contrast, psychotherapeutic treatments provided by an independent therapist were not covered, even if the patient had been referred by a physician.

Under the new law (HIA), Art. 46(1) of the Health Insurance Ordinance (HIO) does not mention non-medical psychotherapists among the persons authorized to provide benefits chargeable to mandatory health insurance. The Federal Insurance Court…