Coverage of care and accommodation costs in hospital for a healthy newborn

Facts

The dispute concerns the question of whether and to what extent the mother's health insurance (KUKO) must cover the costs invoiced by hospital X for the care and stay of the healthy newborn daughter from May 26 to June 2, 1997. The Federal Social Insurance Office (BSV) has filed an administrative law appeal against the decision of the Cantonal Court of Berne, which rejected the mother's claim.

Considerations

The Federal Insurance Court considers that there is a genuine gap in the enumeration of benefits of compulsory health insurance in the event of maternity, as the costs of care and stay of the healthy newborn are not provided for. Although the newborn enjoys the protection of compulsory health insurance, none of the risks mentioned in Art. 1 para. 2 HIA are realized in its case. Moreover, these costs are not included in the specific benefits in the event of maternity either.

Given the concept of maternity insurance for medical benefits anchored in the HIA, which encompasses the pregnancy, childbirth and the mother's convalescence period, it is more logical, from a systematic point of view, to have these costs borne by the mother's insurance, as was already the case under the LAMA. The care given immediately after childbirth to the…