Art. 85 Bundesgesetz vom 18. März 1994 über die Krankenversicherung (KVG) - Einsprache (Art. 52 ATSG )

VVGE.1997.98.Nr.47 · ow (Art. 85 KVG)

Cantonal Cost Coverage for Out-of-Canton Hospitalizations

Cited as the basis for the canton's authority to issue decisions and rulings, including objection decisions, in its role comparable to that of an insurer.

BGE 123 V 128 (Art. 85 LAMal)

Health Insurance Opposition Deadline: Medical Certificates Sent Within 30 Days Constitute an Imperfectly Formulated but Valid Opposition, Requiring the Insurer to Alert the Insured Before Declaring the Decision Final.

Sets the 30-day opposition deadline and the right to oppose, applied in the final order to determine the timeliness and treatment of the insured's opposition.

CDP.2011.192 · ne (art. 85 LAMal)

Insurer Refusal Upheld for Overly Expensive Dental Prosthetic Replacement

Cited in the reasoning regarding the application of proportionality to insurers as holders of public authority.

KV.2004.00019 · zh (Art. 85 ff. KVG)

Physician's Practice Freeze Appeal Denied

Mentioned in the context of determining the court's jurisdiction, specifically when federal legal remedies apply.

16.2004.48 · ti (art. 85 LAMal)

Insurance Premium Jurisdiction Dispute

Cited in the reasoning regarding the competence for LAMal premium recovery, providing context to the distinction relevant to the jurisdictional error.

36.2002.149 · ti (art. 85 LAMal)

Insured v. Health Insurer (Dental Coverage for Gastric Issues)

The judgment was issued as a decision on opposition in accordance with this procedural rule.

36.2002.140 · ti (Art. 85 LAMal)

Insured Denial Upheld for Dental Injury from Homemade Food

Cited as the procedural basis for the administrative decision on opposition which is being reviewed.

36.2003.51 · ti (art. 85 LAMal)

Insured Party v. Health Insurer (Denial of Justice for Failure to Issue Formal Decision)

This article from the old LAMal concerning opposition was discussed in the reasoning, but it is not cited in the dispositive orders.

36.2003.51 · ti (art. 85 LAMal)

Insured Party v. Health Insurer (Denial of Justice for Failure to Issue Formal Decision)

This article on opposition under the new LAMal was cited to explain the new procedure, but it is not the basis for the current order.

36.2002.113 · ti (Art. 85ss LAMal)

Insured v. Health Insurer: Denial of Coverage for Post-Hysterectomy Hospital Stay

These articles regarding administrative procedure were mentioned to contrast the procedural path for social health insurance with that for supplementary insurance.

36.2001.47 · ti (art. 85 LAMal)

Appeal Regarding Mandatory Health Insurance Cost-Sharing Debt and Supplementary Coverage Exclusion

Cited in the dispositive concerning the rejection of the appeal due to untimeliness of the contested decisions.

36.2002.70 · ti (art. 85 LAMal)

Insured Person v. Health Insurance Provider (Acute Psychiatric Hospitalization Coverage)

Cited in the reasoning regarding the application of the proportionality principle to the insurer's actions (as insurers hold public authority).

36.2002.80 · ti (Art. 85 seg. LAMal)

Insured's Appeal on Health Insurance Premiums and Fees Partially Upheld

Cited in the reasoning concerning the possibility to appeal the formal decision, which is a procedural remark related to the final outcome.

36.2002.52 · ti (Art. 85 LAMal)

Social Insurance Sickness Benefit Limitation Upheld Despite Incapacity for Prior Role

This provision concerns the opposition procedure, which was referenced when addressing the appellant's argument about the lack of obligation to motivate the opposition.

36.2002.90 · ti (Art. 80 e 85 LAMal)

Insurer Reimbursement Dispute Dismissed as Moot Following Appeal Confirmation

Cited by the insurance company in the reasoning regarding the applicable law for contesting the decision.