Helsana foregoes the right to claim for reimbursements from home-care services, nursing homes and self-employed care workers

Two Federal Administrative Court decisions clarified that the materials necessary for the provision of care services constitute part of the care services provided and there is no entitlement to receive reimbursements for these materials. As of 2018, Helsana will therefore not pay back the costs of such care materials, but is waiving its right to ask for a reimbursement of the amounts paid out since 2013. These reimbursements would generate unaccountable additional costs and lead to court proceedings. Helsana expects the parties that finance the remaining amounts (cantons and municipalities) to assume the costs of the care materials with immediate effect.

14.06.2018

Two Federal Administrative Court decisions made in September and November 2017 clarified that since the introduction of the new care-financing arrangement, the materials used in the provision of care services are no longer permitted to be charged to the basic insurance. In accordance with the latest case law, the materials are compensated for via the amounts set out in Article 7a (1) and (3) of the Health Care Benefits Ordinance (KLV). Helsana assumed that separate payment under the new care-financing arrangement would also meet legal requirements, which is why the company has not been repaying the costs of care materials in addition to the amounts provided by the care-financing arrangement as of 2018.

The result of this with respect to insurance companies is that too many benefits were paid out between 2013 and 2017. Nevertheless, Helsana is waiving its right to reimbursement of such benefits, as this would generate a disproportional amount of administrative work and lead to court proceedings due to payment requests that would be very difficult to calculate, which would put strain on Helsana’s professional relationships with home-care services, care homes and self-employed care workers. Helsana expects the parties that finance the remaining amounts (cantons and municipalities) to assume the costs of the care materials from 2018 onwards.

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