Introductory Act to the Federal Act on Health Insurance (EGKVG) (EGKVG)

1. The law governs the execution of the mandatory health care insurance and the administration of justice in disputes arising from social health insurance and supplementary insurances.

2. For the supervision of the mandatory health care insurance under Article 6 of the Health Insurance Act (KVG) and for the premium reduction according to Articles 65 et seq. of the Health Insurance Act, the Act on the Reduction of Health Insurance Premiums (Premium Reduction Act) dated January 24, 1995, applies.

3. For the financing of inpatient services of hospitals and maternity homes, the Hospital Act dated September 11, 2006, applies.

4. For the financing of care services under Article 25a of the Health Insurance Act, the Care and Nursing Act dated September 13, 2010, applies.

5. The conditions for the equal treatment of doctors with a cantonal license to operate a pharmacy with licensed pharmacists (Art. 37 para. 3 KVG) are regulated in the Health Act dated September 13, 2005.

1. The Cantonal Council is responsible for

a. acknowledging the planning for an adequate hospital supply (Art. 39 Para. 1d and 3 KVG) within the framework of the planning report according to § 3 Paragraph 3 of the Health Act of September 13, 2005,

b. setting a total amount for the financing of hospitals upon the request of the Governing Council (Art. 5l Para. 1 KVG).

1. The Government Council is responsible for all tasks assigned to it by the KVG and the decrees of the cantonal government or the canton based on it. If federal law assigns a task to the canton, the jurisdiction of other executing bodies remains reserved subject to special provisions.

2. The Government Council is particularly responsible for

a. developing an adequate hospital and nursing home supply (Art. 39 para. 1d and 3 KVG),

b. creating a list of hospitals and nursing homes (Art. 39 para. 1e and 3 KVG),

c. designating a reporting office for providers who refuse to provide services under the KVG (Art. 44 para. 2 KVG),

d. ensuring medical care in case of the withdrawal of service providers (Art. 45 KVG),

e. approving tariff agreements between service providers or their associations and insurers or their associations (Art. 46 para. 4 KVG),

f. setting tariffs in the absence of a tariff agreement between service providers or their associations and insurers or their associations (Art. 47 para. 1 and 2 KVG),

g. extending an existing tariff agreement between service providers or their associations and insurers or their associations (Art. 47 para. 3 KVG),

h. setting a framework tariff (Art. 48 para. 1-3 KVG),

i. ordering operational comparisons between hospitals or nursing homes in collaboration with the Federal Council (Art. 49 para. 8 and 50 KVG),

j. annually determining the cantonal share of the reimbursement of the inpatient services of hospitals and maternity homes (Art. 49a para. 2 KVG),

k. ordering extraordinary measures to control cost development (Art. 54, 55 and 55a KVG),

l. designating the competent cantonal authority for issuing cost approvals for the use of a hospital or maternity home not listed on the cantonal hospital list for medical reasons (Art. 41 para. 3 KVG),

m. designating the audit office that acts in connection with outstanding premiums or cost participations (Art. 64a para. 3 KVG).

1. The Social Insurance Center of the Canton of Lucerne manages a department for outstanding premiums and cost-sharing of mandatory health insurance.

2. ...

3. The department

a. receives reports from insurers on the total amount of claims from mandatory health insurance that have led to the issuance of a certificate of loss or an equivalent legal title (Art. 64a para. 3 KVG),

b. pays the claims in accordance with federal law, provided that the audit authority designated by the government council has confirmed the accuracy of the data (Art. 64a para. 3 and 4 KVG),

c. receives payments from the insurers that they have obtained from the insured individuals (Art. 64a para. 5 KVG).

4. The difference between the paid claims according to subsection 3b and the received amounts according to subsection 3c, as well as the administrative costs of the department, are borne equally by the canton and the municipalities. The share of each municipality is calculated based on the average resident population of the previous year according to the surveys of Lustat Statistics Lucerne.

1. The Cantonal Court adjudicates, as the cantonal insurance court, disputes between insurers among themselves (Art. 87 KVG) or with insured parties or third parties (Art. 58 para. 1 ATSG), concerning the mandatory health care insurance and the voluntary daily allowance insurance. It further adjudicates decisions of the competent cantonal authority regarding the compensation of inpatient services by hospitals and maternity facilities by the canton, and regarding the approval to use a hospital not listed on the cantonal hospital list for medical reasons (Art. 41 para. 3 KVG) pursuant to § 6c of the Hospital Act of September 11, 2006.

2. The procedure is governed by the provisions of the Administrative Procedure Act of July 3, 1972, while ensuring the requirements of Article 61 of the Federal Act on the General Part of the Social Insurance Law of October 6, 2000 (ATSG).

1. The Cantonal Arbitration Tribunal adjudicates disputes between insurers and service providers concerning the mandatory health care insurance and the optional daily allowance insurance (Art. 89 para. 1 KVG). It is seated at the Cantonal Court.

2. It is composed of

a. the President: The Cantonal Court designates him or her from among the cantonal judges by ordinance,

b. two arbitrators: Each party appoints an arbitrator. If a party fails to appoint an arbitrator despite being reminded, the President of the Cantonal Court selects the arbitrator from the relevant party's professional or interest group.

3. The Cantonal Court regulates the procedure within the framework of Article 89 paragraphs 5 and 6 KVG by ordinance.

1. District Courts adjudicate disputes between insurers and insured parties arising from supplementary insurance to social health insurance within the meaning of Article 2, paragraph 2 of the Federal Act on the Supervision of Social Health Insurance dated September 26, 2014.

1. The following enactments are repealed

a. Law concerning the Introduction of the Federal Act on Health and Accident Insurance dated July 2, 1968,

b. Law on Mandatory Health Insurance for Foreign Workers dated May 14, 1957,

c. Law on Insurance against Occupational Accidents and Accident Prevention in Agriculture dated October 4, 1955.

1. The assumption of outstanding premiums and cost-sharing amounts from the mandatory health care insurance, as well as default interest and collection costs that became due before the amendment of the Federal Law on Health Insurance dated March 19, 2010, comes into effect, shall be governed by previous law.

1. The law shall come into effect on August 1, 1998. It is subject to the optional referendum.