Decision 9C_562/2023

29 mars 2024 – In its decision of 18 March 2024, the Federal Supreme Court had to decide whether nursing services must also be covered by the health insurance company (in this case SWICA) if the person concerned has been living in a foundation (special school) and did not use the same services at home. The court partially upheld the appeal against the judgment of the administrative court of the canton of Thurgau.

According to the assessment by Dr. D., specialist in paediatrics and adolescent medicine FMH, dated 21 August 2017, A. (born in 2005) required care from 1 August 2017. A. was insured with SWICA health insurance from 2009 to 2021. During a stay at the C. Foundation (a special school) in 2017, the Children's Nursing Service (Kinderspitex) requested that the costs for the nursing services provided to A. be covered. SWICA rejected this request, arguing that A. was not dependent on these care services as they were not provided at A.'s parents' home.

The court stated that the right to reimbursement of the costs of care services exists regardless of whether they are provided at home or in an institution. The fact that A. was cared for at home by her parents does not mean that she did not need these services during her stay at the C. Foundation.

The fact that the C. Foundation is a special school does not change the fact that A. needed care services because of her disability and not because of her school attendance. The court partly upheld A.'s appeal. It concluded that SWICA had to pay for the nursing services provided by Kinderspitex.

For more information, see here.