Legislator Jurisprudence & Législation
DE FR IT EN
Analyser dans Legislator
V 2023 2 • VG SZ V 2023 2 Généré par l'IA

Midwifery Service Coverage Dispute

Numéro de cause V 2023 2
Autorité / Tribunal
Juridiction Suisse · Canton de Schwytz (CH-SZ)
Date de la décision
Ouvrir la source officielle Miroir Entscheidsuche Version Markdown lisible par machine (.md)

Synthèse Legislator

Généré par l'IA

A company providing midwifery services sued an insurer for payment of services rendered to a client, with the dispute centering on whether the services fell under the scope of mandatory health insurance coverage as stipulated in the relevant federal law. The court reasoned that the criteria for inclusion in the mandatory basic health insurance, which require medical necessity and fulfillment of specific legal conditions for coverage, were not met by the specific services billed, particularly as they did not constitute qualified obstetric care as defined in the regulatory framework, leading to the dismissal of the claim against the insurer.

Regeste Legislator

Généré par l'IA

Midwifery Service Coverage Dispute: The court reasoned that the criteria for inclusion in the mandatory basic health insurance, which require medical necessity and fulfillment of specific legal conditions for coverage, were not met by the specific services billed, particularly as they did not constitute qualified obstetric care as defined in the regulatory framework, leading to the dismissal of the claim against the insurer.

Mots-clés

Généré par l'IA
couverture d'assurance-maladie nécessité médicale prestations fournies protection de la santé compagnie d'assurances maladie et maternité
Généré par l'IA
I 2018 111
Insurance Coverage Dispute Over Massage Costs
II 2023 2
Foreign Medical Treatment Reimbursement Dispute
I 2017 41
Policyholder v. Health Insurer: Reduction Mammoplasty Coverage Dispute
V 2020 4
Healthcare Providers v. Medical Practitioner Reimbursement Dispute
I 2021 51
Claimant v. Insurer: Coverage for Massage Costs for Chronic Ailments

Vous souhaitez savoir comment cet arrêt s'applique à votre dossier ?

Analysez cette décision avec la législation fédérale, le droit cantonal, la doctrine et la jurisprudence subséquente dans Legislator AI.

Ouvrir dans Legislator →

Texte complet

\n \n \n \n \n

\n\n| | | |\n V 2023 2 |\n |\n \n\n

\n \n \n \n \n

\n\n| | | |\n |\n Entscheid vom 19. Dezember 2024 |\n \n\n

\n \n \n \n \n \n

\n\n| | | |\n Besetzung |\n Dr.iur. Vital Zehnder, Vizepräsident |\n

\n|\n |\n Monica Huber-Landolt, Richterin lic.iur. Achilles Humbel, Präsident Cornelia Kälin, dipl. Hebamme HF, Vertreterin Leistungserbringer Dr.rer.oec. Lukas Brunner, Vertreter Versicherer |\n

\n|\n |\n lic.iur. Prisca Reichlin Brügger, Gerichtsschreiberin |\n \n\n

\n \n \n \n \n \n

\n\n| | | |\n Parteien |\n E.________ GmbH, \n Klägerin, \n vertreten durch Rechtsanwalt lic.iur. F.________, |\n \n|\n |\n gegen |\n \n|\n |\n D.________ AG |\n \n\n

\n \n \n \n \n \n

\n\n| | | |\n Gegenstand |\n Schiedsgericht (Forderung aus Hebammen-Dienstleistungen) |\n \n\n

\n \n

Sachverhalt: