Der KI-Arbeitsbereich für Juristen

  • Rechtsrecherche mit Zugriff auf über 1 Million Quellen
  • Dokumentenautomatisierung
  • Mandatsverwaltung
  • Gehostet in der EU und der Schweiz

14 Tage kostenlos testen (10 Fragen/Tag während der Testphase)

Gratis testenDemo buchen

Good-faith reimbursement of a no-longer-covered medicine

ATA/85/1996Cour de justice / Verwaltungskammer13.02.1996

Originalquelle öffnen

Von Omnilex extrahiert

Omnilex-Zusammenfassung

The case concerned a medicine that had ceased to be obligatorily reimbursed under health insurance. The court held that a convention between insurers and pharmacists requiring notice to customers did not bind insured persons, since they were not parties to it. If the insurer itself did not inform its insureds, it must bear the consequences of a pharmacist’s failure to warn when the insured could in good faith assume that coverage continued.

Omnilex-Regeste

LAMA art. 12 para. 2 ch. 1 lit. c; reimbursement of a medicine no longer compulsorily covered by health insurance; the convention between insurers and pharmacists requiring information to customers does not bind insureds, who are not parties to it. Where the insurer has not informed its insureds and the insured could in good faith assume continued coverage, the insurer must bear the consequences of the lack of information and reimburse the costs, notwithstanding the pharmacist’s omission.

Gesamter Gesetzestext

Descripteurs

ASSURANCE SOCIALE; AM; MEDICAMENT; PRINCIPE DE LA BONNE FOI; REMBOURSEMENT DE FRAIS(ASSURANCE); ASSU

Normes

LAMA.12 al.2 ch.1 litt.c

Résumé

Cas d'un médicament qui cesse d'être obligatoirement remboursé par les caisses-maladie. La convention liant les caisses et les pharmaciens, selon laquelle ces derniers doivent rendre leurs clients attentifs au fait que tels médicaments ne sont plus pris en charge par l'assurance, ne lie pas les assurés qui n'y sont pas partie. Par conséquent, il incombe à la caisse qui n'a pas informé ses assurés d'assumer la responsabilité d'un remboursement en cas de défaut d'information de la part du pharmacien, si l'assuré pouvait de bonne foi penser que le médicament en cause continuait à être pris en charge.

Schlagwörter

social insurancehealth insurancemedicinereimbursementgood faithduty to informpharmacistinsured person

Von Omnilex extrahiert

Von Omnilex extrahierte Kernrechtsfragen

Kernrechtsfrage

Whether a health insurer must reimburse a medicine that is no longer mandatorily covered when the insured was not informed of the change.

Extrahierter Entscheid

The insurer may have to bear the reimbursement risk if it failed to inform its insureds and the insured could in good faith believe the medicine was still covered.

Extrahierte Begründung

The convention between insurers and pharmacists, requiring pharmacists to alert customers that certain medicines are no longer covered, does not bind insured persons who are not party to it. If the insurer did not itself inform its insureds, it must bear the consequences of a lack of information communicated by the pharmacist when the insured acted in good faith.

Setzen Sie Ihre Recherche in ChatGPT oder Claude fort

Verbinden Sie Omnilex, um den Rechtskorpus über Ihren KI-Assistenten zu durchsuchen.