Pro rata temporis reimbursement of the premium for the mandatory health insurance in case of death of the insured

Facts

A. B. passed away on 14 June 2014. Prior to her death, she was affiliated for the mandatory health insurance with Helsana Insurances Ltd. [A.], on behalf of the heirs, requested Helsana the pro rata temporis reimbursement of the HIA premium for the period from 15 to 30 June 2014. Helsana refused the reimbursement, arguing that neither the HIA nor the general insurance conditions provide for a payment in proportion to the insurance period in case of death of the insured person. The Cantonal Insurance Court of the Canton of Ticino confirmed Helsana's decision. [A.] therefore filed a public law appeal with the Federal Supreme Court.

Considerations

The Federal Supreme Court partially upheld the appeal, considering that the health insurance premium is not indivisible. In particular, the Federal Supreme Court noted that:

• Art. 24 of the Federal Law on Insurance Contracts (LCA), which entered into force on 1 January 2006, enshrines the principle of divisibility of the premium in the context of private insurance. This new legal provision had not been properly considered in the previous case law (judgment K 72/05 of 14 August 2006).
• There is a direct link between the premium and the insurance coverage, therefore the indivisibility of the premium cannot be justified on the basis of Art. 90 of the Health Insurance Ordinance (OAMal), which only regulates the payment modalities.
• The principle…