Facts
The appellant, a 24-year-old woman, has suffered from the metabolic disorder phenylketonuria since birth. Until her 20th year of life, the Disability Insurance (IV) had covered the costs for the special foods "Damin Flour" and "Aproten". However, the health insurance company Progrès Versicherungen AG refused to cover the costs for these products after the appellant's 20th birthday. The appellant then filed a complaint with the Federal Supreme Court (BGG).Considerations
The Federal Supreme Court upheld the complaint. It stated that according to Art. 52 para. 2 HIA, the therapeutic measures covered by the Disability Insurance (IV) for congenital defects must be included in the benefit catalogue of the mandatory health insurance. Although the two special foods are not listed in the relevant lists (drug list, specialty list, list of medicines for congenital defects), they must nevertheless be reimbursed by the health insurance company, as they are necessary for the treatment of the appellant's phenylketonuria. The Federal Supreme Court emphasized that the legislator intended with…