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ATA/688/1998•Valid notice of health insurance premium increase
ATA/688/1998Cour de justice / Chambre administrative3 nov. 1998Modified
Extrait par Omnilex
The court held that a computer-generated premium-increase notice, written in German and sent to a French-speaking insured, was too unclear to count as valid notice under Art. 7 LAMal. The cancellation period therefore did not start with that document. It began only when the insured, in good faith, could and had to realize that the premium had increased, here upon receipt of the new payment slips.
Art. 7 LAMAL; notification of premium increases and commencement of the cancellation period; a notice of premium increase must be sufficiently clear and understandable to the insured. A cryptic computer printout, particularly when addressed in the wrong language to a multilingual insured, does not by itself trigger the cancellation period. That period begins only when the insured can and must, in good faith, recognize the increase with sufficient certainty (consid. not specified).
Descripteurs
ASSURANCE SOCIALE; AM; PRIME D'ASSURANCE; RESILIATION; PRINCIPE DE LA BONNE FOI; ASSU
Normes
LAMAL.7 al.2
Résumé
Un imprimé informatique de présentation sibylline, de surcroît adressé en allemand à un assuré francophone, ne constitue pas une annonce valable d'augmentation de primes faisant courir le délai de résiliation de l'article 7 LAMal. Ce délai court dès le moment où l'assuré peut et doit de bonne foi admettre qu'il a eu connaissance de l'augmentation, en l'occurrence dès réception des nouveaux bulletins de versement.
Extrait par Omnilex
Whether a confusing premium-increase notice sent in German to a French-speaking insured is valid notice under Art. 7 LAMal
No. Such a document does not constitute valid notice of a premium increase capable of triggering the cancellation period.
A notice must be clear enough for the insured to understand the increase. A cryptic computer printout, especially in the wrong language, does not satisfy that requirement.
When the cancellation period begins to run for a premium increase under Art. 7 LAMal
It begins when the insured can and must, in good faith, recognize that the premiums have increased; in this case, upon receipt of the new payment slips.
The decisive moment is not the defective notice itself but the point at which the insured actually or constructively learns of the increase in a manner consistent with good faith.
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