Facts
The plaintiff, A., is insured with SWICA Gesundheitsorganisation. On November 13, 1998, she underwent an operation to remove her wisdom teeth 28 and 38 (left) by Dr. med. dent. S. The invoice of Fr. 924.35 was sent to SWICA for reimbursement. SWICA recognized Fr. 140.95 as a mandatory benefit for the treatment of a skin alteration performed by the doctor on this occasion, but refused to cover the remaining costs of Fr. 783.40 for the removal of the two wisdom teeth and the treatment of the associated pathology.
The plaintiff appealed against this decision, which was rejected by the Administrative Court of the Canton of Berne. The plaintiff then appealed to the Federal Insurance Court, requesting that the treatment be recognized as a mandatory benefit of the health insurance and that the costs be reimbursed.
Considerations
The Federal Insurance Court examined the question of whether the costs of treating dislocated wisdom teeth should be covered by the mandatory health insurance. It considered that dislocated wisdom teeth are not necessarily a serious illness that justifies coverage of the costs by the mandatory health insurance.
The Court recalled that the costs of dental treatments are only covered by the mandatory health insurance in limited cases, in particular when it is a serious illness of the dental system or a serious general illness. It also emphasized that dislocated wisdom teeth are not necessarily a serious illness that justifies coverage of the costs by the mandatory health insurance.
The Court concluded that the costs of treating…