Coverage of hospitalization costs in an establishment outside the canton of residence

Facts

G., domiciled in the canton of Vaud, is insured with the health insurance fund ASSURA. For personal reasons, he wishes to undergo surgery for bilateral glaucoma at the Inselspital in Bern, which is not on the list of hospitals in the canton of Vaud. The insurance fund refuses to guarantee the coverage of hospitalization costs, on the grounds that this hospital is not an approved healthcare provider in the insured's canton of residence. The Insurance Court of the canton of Vaud ruled that the insurance fund must guarantee the coverage of costs according to the rates applicable in the canton of Vaud. ASSURA has appealed this decision.

Considerations

The Federal Insurance Court considered that Art. 41 para. 1 HIA recognizes the insured's free choice of hospital among the establishments in Switzerland meeting the requirements of Art. 39 HIA, without being limited to only those establishments on the list of the canton of residence. The cantonal hospital planning aims to ensure the coordination of healthcare providers and cost control, but cannot restrict the rights of the insured as defined by the HIA.

Therefore, the insurance fund is required to guarantee…