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V 2023 2 • VG SZ V 2023 2 Generato dall'IA

Midwifery Service Coverage Dispute

Numero d'incarto V 2023 2
Autorità giudiziaria
Giurisdizione Svizzera · Canton Svitto (CH-SZ)
Data della decisione
Apri la fonte ufficiale Archivio Entscheidsuche Versione Markdown leggibile dalle macchine (.md)

Sintesi Legislator

Generato dall'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.

Regesto Legislator

Generato dall'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.

Parole chiave

Generato dall'IA
copertura dell'assicurazione malattie necessità medica prestazioni erogate protezione della salute compagnia d'assicurazioni malattia e maternità
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Testo completo

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

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

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\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

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