Insured's Claim for Reimbursement against the Health Insurance under the Tiers Garant System

Facts

R. was compulsorily insured for healthcare with avanex Versicherungen AG (avanex) as of 1 January 2007. In 2007, she was under outpatient treatment with Dr. med. G. On 2 April 2007, Dr. med. G. invoiced her an amount of CHF 880.60 for the period from 11 January to 15 March 2007. When R. claimed this amount back on 2 April 2012, avanex denied the obligation to pay, arguing that the claim was time-barred. The Administrative Court of the Canton of Bern upheld R.'s appeal and overturned the objection decision. avanex then filed an appeal in public law matters with the Federal Supreme Court.

Considerations

The Federal Supreme Court decided that the five-year time limit pursuant to Art. 24 para. 1 GSSLA for the insured's claim for reimbursement under the Tiers Garant system (Art. 42 para. 1 HIA) begins to run upon receipt of the invoice by the insured person. As the invoice from Dr. med. G. was received by R. at the…