Facts
The plaintiff [E.] was insured with the health insurance company [X.] through the supplementary insurances BASIC 1 and 2. The defendant changed the product BASIC 2 twice, most recently as of January 1, 1997. The plaintiff demanded that the defendant cover the costs of dental treatments in Germany. The Social Insurance Court of the Canton of Zurich dismissed the complaint. The plaintiff appealed and requested the reversal of the judgment and the obligation of the defendant to pay her a reasonable party compensation.
The parties
- Plaintiff: [E.] , Zurich
- Defendant: Health insurance company [X.] , Zurich
The Social Insurance Court of the Canton of Zurich dismissed the complaint with a judgment of September 28, 2000. The plaintiff requested the reversal of the judgment and the obligation of the defendant to pay her a reasonable party compensation.
Considerations
The Federal Court examined the appeal and came to the following conclusion: The appeal is admissible, as the Social Insurance Court has determined that the amount in dispute exceeds CHF 8,000.--. However, the plaintiff has not filed the required claim to invoke the guarantee of existing contracts pursuant to Art. 102 para. 2 sentence 3 HIA.
The guarantee of existing contracts only applies if a contract concluded under the old law continues beyond the date of entry into force of the HIA (January 1, 1996). Since the parties concluded a new supplementary insurance contract on January 1, 1996, and on January 1, 1997, respectively, one of the prerequisites required for the applicability of Art. 102 para. 2 sentence 3 HIA is lacking.
The plaintiff cannot enter into a new contract with a reduced scope of benefits and subsequently invoke the guarantee of existing contracts. The lower court rightly determined…