Facts
In this case, the appellant suffers from a congenital lower prognathism with an ANB angle of -3° and several permanent antagonistic teeth in a crossed position. She requests the reimbursement of her dental treatments by the mandatory health insurance. The Insurance Court of the Canton of Ticino and the Helsana insurance company rejected her request, considering that the treatments were not necessary after her 20th birthday within the meaning of Art. 19a para. 1 let. a HIBO. The appellant then appealed to the Federal Insurance Court.Considerations
The Federal Insurance Court considers that Art. 19a para. 1 let. a HIBO must be interpreted in such a way that only dental treatments related to a congenital disability which, for medical reasons, require an intervention beyond the age of 20, are covered by the mandatory health insurance. This interpretation is based on the history of the provision, which aims to fill a gap in disability…