Moti­on SPK‑N (19.3963): Inclu­si­on of case manage­ment mea­su­res in the tasks of the bodies respon­si­ble for the health insuran­ce sector

Moti­on SPK‑N (19.3963): Inclu­si­on of case manage­ment mea­su­res in the tasks of the bodies respon­si­ble for the health insuran­ce sector

Sub­mit­ted text

The Federal Coun­cil is inst­ruc­ted to sub­mit a draft amend­ment to the Federal Health Insuran­ce Act of March 18, 1994 (KVG), with which Case manage­ment mea­su­res in the sta­tu­to­ry tasks of the bodiesent­ru­sted with the imple­men­ta­ti­on of this Act or the Federal Act of 26 Sep­tem­ber 2014 on the Super­vi­si­on of Social Health Insuran­ce, the con­trol or the super­vi­si­on of the imple­men­ta­ti­on. The amend­ment is also inten­ded to crea­te the legal basis requi­red for the imple­men­ta­ti­on of case manage­ment mea­su­res for the pro­ces­sing of per­so­nal data, inclu­ding par­ti­cu­lar­ly sen­si­ti­ve per­so­nal data and per­so­na­li­ty profiles.

In the event that the revi­si­on of the Federal Data Pro­tec­tion Act (FADP) is adop­ted, ins­tead of a legal basis for the pro­ces­sing of per­so­na­li­ty pro­files, a legal basis for pro­filing and the making of auto­ma­ted indi­vi­du­al deci­si­ons wit­hin the mea­ning of the future FADP must be pro­vi­ded. This app­lies to all sta­tu­to­ry tasks of the afo­re­men­tio­ned bodies.

Justi­fi­ca­ti­on

Case manage­ment mea­su­res are not part of the cata­log of tasks under the KVG. Con­se­quent­ly, the bodies ent­ru­sted with the imple­men­ta­ti­on of this Act can­not rely on this Act for the pro­ces­sing of per­so­nal data with regard to the­se mea­su­res. In this case, exclu­si­ve­ly Arti­cle 17(2)(c) DPA app­li­ca­ble. Thus, health insu­rers may only use per­so­nal data for case manage­ment mea­su­res in excep­tio­nal­ly and after obtai­ning the con­sent pro­cess the data sub­ject in the indi­vi­du­al case. The­se requi­re­ments impair the effec­ti­ve­ness of the mea­su­res and threa­ten to pre­vent their deve­lo­p­ment and the asso­cia­ted bene­fits for the insuran­ce com­pa­nies and the per­sons con­cer­ned. For the case manage­ment mea­su­res, par­ti­cu­lar­ly sen­si­ti­ve per­so­nal data must be pro­ces­sed, but per­so­na­li­ty pro­files must also be crea­ted. The legal basis for pro­ces­sing must con­se­quent­ly also inclu­de the­se spe­cial cate­go­ries of per­so­nal data.

The draft revi­si­on of the FADP abolishes the con­cept of per­so­na­li­ty pro­filing and intro­du­ces the con­cept of pro­filing and auto­ma­ted indi­vi­du­al deci­si­on-making. In the event that the draft revi­si­on is adop­ted, the legal basis in the KVG must be adap­ted and pro­vi­si­on made for the com­pe­tent bodies to be able to car­ry out pro­filing and issue auto­ma­ted indi­vi­du­al deci­si­ons for case manage­ment mea­su­res and their other sta­tu­to­ry tasks.