Federal Supreme Court, Decision 9C_45/2021 of 16 April 2021

14 mai 2021 – In this decision, the Federal Supreme Court had to decide whether the insured person, after being removed from the list of defaulting premium payers, was in principle entitled to the previously deferred benefits. The lower court had denied this on the grounds that, in principle, entitlement only exists if the outstanding claims have been settled or, equivalently, the corresponding debt collection proceedings have been discontinued or concluded. The decisive factor was therefore the reason for the deletion from the list. If this occurred because the person concerned had moved away from the canton of Aargau, this did not result in a "retroactive obligation to pay" (recte: obligation to pay in arrears). The appellant disagreed and essentially argued that the cancellation of the deferment of benefits (and thus the entitlement to subsequent payment) did not require prior deletion from the list.

After careful consideration, the court came to the conclusion that the appellant was in principle entitled to subsequent payment of the withheld insurance benefits. The insurance company will have to examine the material conditions for entitlement in accordance with art. 24 para. 1 of the Federal Health Insurance Act (KVG), on which it has not yet made a statement. The appeal was therefore partially upheld and referred back to the insurance company for a new decision.

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