Facts
The plaintiff, A., has been insured with CSS Insurance for many years. She concluded a new health insurance contract "Hospital Insurance Semi-Private, Medical Expenses Insurance" in October 2004. The plaintiff was treated as an inpatient at the Frauenklinik am Meissenberg from April 29 to June 7, 2005. CSS rejected the cost approval because the clinic did not have a tariff agreement with CSS.
The plaintiff sued the District Court of Lucerne-Stadt and demanded the difference between 75% of the total invoice amount for the hospital stay and the OKP lump sum guaranteed by CSS. The District Court sentenced CSS to pay CHF 28,209.60 plus interest. CSS appealed, and the High Court of the Canton of Lucerne dismissed the complaint in its entirety.
The plaintiff filed a federal appeal and demanded that CSS be obliged to pay CHF 33,588.25 plus interest from October 10, 2005. The Federal Court dismissed the appeal.
Considerations
The Federal Court has decided that the liability of the supplementary insurance for inpatient treatment in a clinic without a tariff agreement is not given. The lower court has established that the GTC of the "Hospital Insurance Semi-Private" provide for a liability only for hospitals with a tariff agreement.
The plaintiff argued that the transfer from the old KUVG to the new HIA and the resulting transfer of old-law supplementary insurances under KUVG to the new private-law supplementary insurances according to Art. 102 para. 2 HIA should guarantee the previous status, i.e., the previous scope of benefits. However, the Federal Court has decided that the transitional legal bestand guarantee of Art. 102 para. 2…