Rs 832.112.31 Order Of The Dfi Of 29 September 1995 On Benefits In The Compulsory Care In Case Of Illness (Ordinance On Benefits Insurance Care, Asds)

Original Language Title: RS 832.112.31 Ordonnance du DFI du 29 septembre 1995 sur les prestations dans l’assurance obligatoire des soins en cas de maladie (Ordonnance sur les prestations de l’assurance des soins, OPAS)

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832.112.31 order of the DFI on benefits in compulsory insurance for care in case of illness (healthcare, ASDS insurance benefits Ordinance) on 29 September 1995 (Status January 1, 2016) the federal Department of Home Affairs (FDHA), view the art. 33, 36, al. 1, 54, al. 2-4, 59, 62, 65, al. 3, 65b, al. 3, 65f, al. 5, 65g, al. 3, 70, 75, 77, al. 4, and 104 of the Ordinance of 27 June 1995 on health insurance (OAMal), stop: title 1 benefits Chapter 1 benefits doctors, chiropractors and pharmacists Section 1 repaid benefits art. 1 are given in annex 1 the benefits covered by art. 33, let. a and c, OAMal, which were examined by the Federal Commission of general benefits and the principles of insurance and compulsory insurance for care (insurance): a. supports costs; b. supports costs under certain conditions; c. does not support costs.

New content according to section I of the O of the DFI on Dec. 10. 2008, in force since Jan. 1. 2009 (RO 2008 6493).

Section 2 psychotherapy practiced by a doctor art. 2Principe insurance supports the costs of psychotherapy based on methods whose effectiveness is scientifically proven by a doctor.
Psychotherapy is a form of treatment that: a. is psychic and psychosomatic diseases; b. has a defined therapeutic objective c. is based mainly on verbal communication, but does not support drug treatment; d. is based on a theory of experience and behaviour normal and pathological as well as etiologic diagnosis; e. includes the systematic reflection and an ongoing therapeutic relationship; f. is characterized by a report of trust as well as work by regular and scheduled therapy sessions; g. can be practised as individual, family therapy, couple or group.

New content according to chapter I of O of the DFI on June 5, 2009, in force since July 1. 2009 (2009 2821 RO).

Art. 3Prise supported insurance supports the costs for a maximum of 40 diagnostic and therapeutic sessions. Art. 3B is reserved.

New content according to chapter I of O of the DFI on June 5, 2009, in force since July 1. 2009 (2009 2821 RO).

Art. 3 introduced by section I of O of the DFI on 3 July. 2006 (RO 2006 2957). Repealed by no I of O of the DFI on June 5, 2009, with effect from July 1. 2009 (2009 2821 RO).

Art. 3bprocedure for support in the event of continuation of therapy after 40 sessions to ensure that, after 40 sessions, insurance continues to take the costs of psychotherapy, the attending physician must report to the medical officer of the insurer in time. The report should include: a. the type of disease; b. the type, the frame, the conduct and the results of the treatment started; c. a proposed extension of therapy indicating the purpose, the framework and duration probable;

The report may contain only data necessary for the insurer to assess the support obligation.
Medical consultant reviews the report and proposes to the insurer to continue psychotherapy in charge of insurance, indicating its duration until the next report, or to interrupt.
The insurer shall communicate to the insured person, with a copy to the attending physician, within 15 working days of receipt of the report by the medical officer if he continues to support the costs of psychotherapy and for how long.

Introduced by chapter I of the O of the DFI on 3 July. 2006 (RO 2006 2957). New content according to chapter I of O of the DFI on June 5, 2009, in force since July 1. 2009 (2009 2821 RO).

Art. 3 c and 3d introduced by chapter I of O of the DFI from 3 July. 2006 (RO 2006 2957). Repealed by section I of O of the DFI on June 5, 2009, with effect from July 1. 2009 (2009 2821 RO).

Section 3 benefits prescribed by chiropractors art. 4. insurance supports analyses, the drugs, the diagnostic or therapeutic devices and ways, reviews by imaging and the benefits of physiotherapy, prescribed by chiropractors, who follow: a. Analysis: in application of art. 62, al. 1, let. b, OAMal, analyses are identified separately in the list of tests; b. drugs: pharmaceutical specialities of the following therapeutic groups to the list of specialties, under categories B (delivery by pharmacies on prescription), C (discount on health professionals Council) or D (discount on Council of specialists): 1. 01.01.10 (antipyretic analgesics), 01.12 (myotonolytica: oral only) 2. 04.99 (gastroenterologica, varia: only the Proton pump inhibitors), 3. 07.02.10 (mineralia), 07.02.20 (compound minerals), 07.02.30 (simple vitamins), 7.07.02.40 (compound vitamins), 07.02.50 (other associations), 4. 07.10.10 (anti-inflammatory simple), 07.10.21 (anti-inflammatory compounds without corticosteroids: only associations of anti-inflammatory drugs and Proton pump inhibitors), 07.10.40 (skin preparations: only those containing active anti-inflammatory products), 5. 57.10.10 (complementary medicine: anti-inflammatory simple);

c. means and devices: 1. the products of the Group 05. Bandages, 2. the products of the Group 09.02.01 Transcutaneous electrical neurostimulation devices (TENS), 3. the products of the Group 16. Articles for cryotherapy and/or thermotherapy, 4. the products of the Group 23. Orthotics, 5. the products of the Group 34. Material for dressings;

d. Imaging studies: 1 x-ray of the skeleton, 2 scanner (CT) of the spine and extremities, 3. nuclear magnetic resonance (MRI) of the axial skeleton and the peripheral joints, 4. diagnostic ultrasound, 5. bone scan in three phases;

e. benefits of physiotherapy under art. 5. new content according to chapter I of O of the DFI on June 24, 2009, in force since Jan. 1. 2011 (RO 2009 3527 6849 ch. I).
New content according to section I of the O of the DFI on Nov. 17. 2003, in force since Jan. 1. 2004 (RO 2003 5283).
New content according to chapter I of O of the DFI on May 16, 2014, in force since July 1. 2014 (2014 1251 RO).
New content according to chapter I of O of the DFI on June 10, 2013, in force since July 1. 2013 (2013 1925 RO).
Introduced by chapter I of O of the DFI on 10 July. 2000 (RO 2000 2546). New content according to chapter I of O of the DFI on June 10, 2013, in force since July 1. 2013 (2013 1925 RO).
Introduced by chapter I of O of the DFI on June 24, 2009, in force since Jan. 1. 2011 (RO 2009 3527 6849 ch. I).

Section 4Prestations provided by pharmacists art. 4A insurance supports the costs of the following services provided by pharmacists: a. advice when executing a prescription containing at least a drug from the list of specialties; b. running a prescription outside normal hours, emergency; c. replacement of an original or of a generic preparation prescribed by a doctor by a cheaper generic; d. assistance prescribed by a doctor When taking a drug. Insurance can take over, as part of a wage agreement, the costs of more extensive benefits to reduce costs, provided for a group of insureds.

Chapter 2 benefits provided on prescription or medical term Section 1 physiotherapy art. 5. the following services of physiotherapists, to the senses of the art. 46 and 47 OAMal or organizations, to the senses of the art. 52A OAMal, are supported when they are supplied on medical prescription and in the treatment of musculoskeletal or neurological or systems of internal organs and vessels, as far as physical therapy to treat them: a. measures relating to the review and evaluation physiotherapy; b. therapeutic measures, advice and instruction: 1. active and passive physiotherapy 2. manual therapy, 3. detonifiante physiotherapy, 4. respiratory physiotherapy (y c. by aerosol inhalations), 5. medical training therapy, 6. physiotherapy lymphologique, 7. physical therapy in the water, 8. hippotherapy in multiple sclerosis, 9. cardiovascular physical therapy, 10. physical therapy of the pelvic floor;

c. physical measures: 1. therapy of warm and cold, electrotherapy 2, 3 light therapy (ultraviolet, infrared, colorful rays), 4. Ultrasound, 5. hydrotherapy, 6. muscle and connective tissue massages.

The measures referred to in para 1, let. b, ch. 1, 3 to 5, 7 and 9 can be applied individually or in groups.
The medical training therapy begins with an introduction to the training carried out on devices and ends at the most in the next three months. It trumps individual physiotherapeutic treatment.
Insurance is supported by medical prescription, at most the cost of nine sessions, the first treatment to take place in the five weeks following the prescription.
A new prescription is needed for the support of a greater number of sessions.

So that, after treatment equivalent to 36 sessions, it continues to be supported, the attending physician must submit a report to the medical officer of the insurer and provide a duly motivated proposal. The medical officer proposes to continue or not the therapy at the expense of insurance, indicating to what extent and at what time the next report is due.
For insured persons entitled to benefits until the age of 20 years provided for in art. 13 of the Federal Act of 19 June 1959 on disability insurance, management of costs in case of pursuit of already begun physiotherapy is carried out, after the age of 20, within the meaning of para. 4. new content according to section I of the O of the DFI on October 27. 2009, in force since Jan. 1. 2010 (2009 6083 RO).
New content according to section I of the O of the DFI on October 27. 2009, in force since Jan. 1. 2010 (2009 6083 RO).
New content according to chapter I of O of the DFI on June 5, 2009, in force since July 1. 2009 (2009 2821 RO).
Introduced by chapter I of O of the DFI on June 5, 2009, in force since July 1. 2009 (2009 2821 RO).
Introduced by chapter I of O of the DFI on June 5, 2009, in force since July 1. 2009 (2009 2821 RO).
New content according to chapter I of O of the DFI on June 5, 2009, in force since July 1. 2009 (2009 2821 RO).
Introduced by section I of O of the DFI of Dec. 9. 2002 (RO 2002 4253). New content according to section I of the O of the DFI on Dec. 10. 2008, in force since Jan. 1. 2009 (RO 2008 6493).
RS 831.20 introduced by section I of O of the DFI on 10 dec. 2008 (RO 2008 6493). New content according to chapter I of O of the DFI on June 5, 2009, in force since July 1. 2009 (2009 2821 RO).

Section 2 occupational therapy art. 6. the services provided, medical prescription, by occupational therapists and occupational therapy organizations, to the senses of the art. 46, 48 and 52 OAMal, are supported because: a. they provide the insured, in case of somatic disorders, thanks to an improvement in bodily functions, independence in the performance of the ordinary activities of life; forgotten the source. they are carried out in the context of psychiatric treatment.

Insurance is supported by medical prescription, as the costs of nine sessions, the first treatment to take place within eight weeks following the medical prescription.
A new prescription is needed for the support of a greater number of sessions.
So that, after treatment equivalent to 36 sessions, it continues to be supported, the attending physician must submit a report to the medical officer of the insurer and provide a duly motivated proposal. The medical officer proposes to continue or not the therapy at the expense of insurance, indicating to what extent and at what time the next report is due.
For insured persons entitled to benefits until the age of 20 years provided for in art. 13 of the Federal Act of 19 June 1959 on disability insurance, management of costs in case of pursuit of an already started occupational therapy is carried out, after the age of 20, within the meaning of para. 4. new content according to chapter I of O of the DFI on Dec 13. 1996, in force since Jan. 1. 1997 (RO 1997 564).
New content according to chapter I of O of the DFI on June 5, 2009, in force since July 1. 2009 (2009 2821 RO).
Introduced by section I of O of the DFI of Dec. 9. 2002 (RO 2002 4253). New content according to section I of the O of the DFI on Dec. 10. 2008, in force since Jan. 1. 2009 (RO 2008 6493).
RS 831.20 introduced by section I of O of the DFI on 10 dec. 2008 (RO 2008 6493). New content according to chapter I of O of the DFI on June 5, 2009, in force since July 1. 2009 (2009 2821 RO).

Section 3 ambulatory care provided in a nursing article 7 definition of care benefits within the meaning of art. 33, let. b, OAMal include examinations, treatment and care made according to the assessment of care according to para. 2, let. a, and according to art. 8 on prescription or medical term by of: a. nurses (art. 49 OAMal); b. organizations care and assistance at home (art. 51 OAMal); c. medico-social institutions (art. 39, al. 3 of the Federal ACT of 18 March 1994 on health insurance, LAMal).

Benefits within the meaning of para. 1 include: a. the assessment, advice and coordination: 1. assessment of the needs of the patient and the environment of the latter; planning, in collaboration with the doctor and the patient, necessary measures, 2. advice to the patient and, where applicable, non-professional stakeholders for care, particularly how to manage the symptoms of the disease, for the administration of drugs or medical devices; necessary controls, 3. coordination of measures and provisions by nurses specialized in connection with complications in care complex and unstable situations;

b. tests and treatments: 1. check vital signs (blood pressure, pulse, temperature, respiration, weight), 2. simple test of glucose in the blood or urine, 3. sampling for laboratory examination, 4. therapeutic measures for breathing (such as oxygen, inhalations, simple breathing exercises, aspiration), 5. installation of probes and catheters, as well as care related, 6. care in the case of hemodialysis or peritoneal dialysis, 7. preparation and administration of medicines as well as documentation of the activities that are associated with, 8. administration of enteral or parenteral nutrient solutions, 9. monitoring of infusions, transfusions or devices used for the control and maintenance of the vital functions or to medical treatment, 10. rinsing, cleaning and dressing wounds (including pressure sores and ulcers) and cavities of the body (including care for Trach-Ostomy and Ostomates), care pedicures for diabetics, 11. care in case of disorders of the urinary or bowel evacuation, including rehabilitation, incontinence, 12. assistance for medicinal baths, partial or complete, application of wraps, poultices and fangos, 13. care for the implementation on a daily basis of the medical therapy, such as the exercise of strategies for managing the disease and training for management of aggression, anxiety and paranoid ideas, 14. support for the mentally ill in crisis situations, in particular to avoid acute situations endangering self or others;

c. basic care: 1. General for dependent patients basic care, such as: bend the legs of the patient, put compression stockings, make his bed, install it, make him do exercises, mobilise it, preventing pressure sores, prevent and treat the consecutive treatment skin lesions; help with care and hygiene of the mouth; help the patient to dress and undress, so what to eat, 2. measures to monitor and to support the mentally ill to perform the acts of ordinary life, such as planning and structuring their days in an appropriate manner, and the promotion of contacts with targeted training and support during the use of AIDS to orientation and the use of security measures.

The following conditions must be met: a. the benefits referred to in para. 2, let. a, point 3, must be provided by a nurse or a nurse (art. 49 OAMal) that could justify a professional experience of two years in interdisciplinary collaboration and the management of patients in networks; b. it belongs to a nurse or a nurse (art. 49 OAMal) that could justify a professional experience of two years in the psychiatric evaluation field if measures such as those which are provided for in para. 2, let. b, ch. 13 and 14, and c, no. 2, must be taken.

Benefits can be provided in an ambulatory way or in a nursing. It may also be supplied exclusively during the day or at night.
Are deemed services of acute care and transition to the senses of the art. 25, art. 2, lAMal, the services referred to in para. 2, provided by persons or institutions within the meaning of para. 1, let. a-c, according to the assessment of care required under para. 2, let. a, and art. 8, after a hospital stay and prescription of a doctor at the hospital.

RS 832.10 new content according to chapter I of O of the DFI on June 24, 2009, in force since Jan. 1. 2011 (RO 2009 3527 6849 ch. I).
New content according to chapter I of O of the DFI on Dec 20. 2006, in force since Jan. 1. 2007 (RO 2006 5769).
New content according to chapter I of O of the DFI on Dec 20. 2006, in force since Jan. 1. 2007 (RO 2006 5769).
New content according to section I of the O of the DFI on Dec. 5. 2011, in force since Jan. 1. 2012 (2011 6487 RO).
Introduced by section I of O of the DFI of Dec. 5. 2011, in force since Jan. 1. 2012 (2011 6487 RO).
New content according to section I of the O of the DFI on Dec. 5. 2011, in force since Jan. 1. 2012 (2011 6487 RO).
Introduced by section I of O of the DFI of Dec. 20. 2006, in force since Jan. 1. 2007 (RO 2006 5769).
Introduced by section I of O of the DFI of Dec. 20. 2006, in force since Jan. 1. 2007 (RO 2006 5769).
New content according to chapter I of O of the DFI on Dec 20. 2006, in force since Jan. 1. 2007 (RO 2006 5769).

Introduced by section I of O of the DFI of Dec. 20. 2006 (RO 2006 5769). New content according to section I of the O of the DFI on Dec. 5. 2011, in force since Jan. 1. 2012 (2011 6487 RO).
Introduced by chapter I of O of the DFI on June 24, 2009, in force since Jan. 1. 2011 (RO 2009 3527 6849 ch. I).
Introduced by chapter I of the O of the DFI on 3 July. 1997 (RO 1997 2039). New content according to chapter I of O of the DFI on June 24, 2009, in force since Jan. 1. 2011 (RO 2009 3527 6849 ch. I).

Art. 7aMontants for service providers referred to in art. 7, al. 1, let. a and b, the insurance covers the following amounts per hour, on the cost of the benefits defined in art. 7, al. 2: a. for the services defined in art. 7, al. 2, let. a: fr. 79, 80; (b) for the services defined in art. 7, al. 2, let. b: CHF 65, 40; c. for the services defined in art. 7, al. 2, let. c: 54 fr. 60.

The repayment of the amounts, according to para. 1, is made per unit of time of 5 minutes. At least 10 minutes are reimbursed.
For service providers referred to in art. 7, al. 1, let. c, insurance supports the following amounts per day, on the cost of the benefits defined in art. 7, al. 2: a. up to 20 minutes of care required: 9 francs; b. from 21 to 40 minutes of care required: 18 francs; c. 41 to 60 minutes of care required: 27 francs; d. 61 to 80 minutes of care required: 36 francs; e. from 81 to 100 minutes of care required: 45 francs; f. 101 to 120 minutes of care required : 54 francs; g. from 121 to 140 minutes of care required: 63 francs; h. from 141 to 160 minutes of care required: 72 francs; i. from 161 to 180 minutes of care required: 81 francs; j. 181 to 200 minutes of care required: 90 francs: k. 201 to 220 minutes of care required: 99 francs; l more than 220 minutes of care required. : 108 francs.

For healthcare facilities of day or night according to art. 7, al. 2, the insurance covers the amounts according to para. 3, by day or night, on the cost of the benefits defined in art. 7, al. 2. introduced by chapter I of O of the DFI on June 24, 2009, in force since Jan. 1. 2011 (RO 2009 3527 6849 ch. I).

Art. 7bPrise acute care and transition the canton of residence and insurers support the benefits of acute care and transition costs, according to their respective shares. The canton of residence for each calendar year, at the latest nine months before the beginning of the calendar year, the cantonal share for the inhabitants of the canton. It is around 55% at least.
The canton of residence pays its share of the compensation directly to the service provider. The terms agreed between the service provider and the canton of residence. The insurer and the canton of residence may agree that the canton pays his share to the insurer and pays the two parts to the service provider. The billing between the service provider and the insurer is regulated in art. 42 lAMal.

Introduced by chapter I of O of the DFI on June 24, 2009, in force since Jan. 1. 2011 (RO 2009 3527 6849 ch. I).
RS 832.10 art. 8Prescription or medical term and required care assessment the prescription or the medical term determines, on the basis of the assessment of required care and joint planning, the services to be performed by nurses or aid and home care organizations.
Are included in the assessment of the care required, the appreciation of the general State of the patient, his environmental assessment as well as the care and assistance he needs.
The assessment of care required is based on uniform criteria. The results are reported on a form. This shall include the necessary time. Tariff partners establish a standard form.
The assessment of acute care and transition required is based on uniform criteria. The results are reported on a single form.
The care required in the nursing assessment is based on required care needs (art. 9, al. 2). The required care need determined by the doctor takes the place of order or medical term.
Insurers may require the evaluation of care required data are communicated to them under the benefits provided for in art. 7, al. 2. the duration of the prescription or medical term may not exceed: a. three months when the patient is suffering from an acute illness; b. six months when the patient is suffering from a long-term illness; c. two weeks when the patient needs acute care and transition.

The medical certificate justifying the allocation for serious impotence or average paid by old-age insurance and survivors, by disability insurance or accident insurance worth as prescription or medical term of unlimited duration regarding care benefits necessitated by impotence. When the allowance is revised, the insured must communicate the outcome of the review to the insurer. A prescription or a medical mandate must be established as a result of the revision of the allocation for impotent.
The prescription or the medical term, according to para. 6, let. a and b, can be renewed.

New content according to chapter I of the O of the DFI from 3 July. 1997, in force since Jan. 1. 1998 (RO 1997 2039).
Introduced by chapter I of O of the DFI on June 24, 2009, in force since Jan. 1. 2011 (RO 2009 3527 6849 ch. I).
New content according to chapter I of O of the DFI on June 24, 2009, in force since Jan. 1. 2011 (RO 2009 3527 6849 ch. I).
New content according to chapter I of O of the DFI on June 24, 2009, in force since Jan. 1. 2011 (RO 2009 3527 6849 ch. I).
Introduced by section I of O of the DFI of Sept. 18. 1997, in force since Jan. 1. 1998 (RO 1997 2436).
New content according to chapter I of O of the DFI on June 24, 2009, in force since Jan. 1. 2011 (RO 2009 3527 6849 ch. I).

Art. 8aprocedure control and conciliation providers of services within the meaning of art. 7, al. 1, let. a and b, and the insurers agree to a procedure and control of joint conciliation for ambulatory care.
Failing agreement, the cantonal government fixed, after hearing the parties, the procedure of control and conciliation under para. 1. the procedure used to check the validity of the assessment of required care and control adequacy and economic character of the benefits. Prescriptions or medical terms can be examined by the medical officer (art. 57 KVG) when they plan more than 60 hours of care per quarter. When they anticipate less than 60 hours of care per quarter, they are reviewed by polls.

Introduced by chapter I of the O of the DFI on 3 July. 1997 (RO 1997 2039). New content according to chapter I of O of the DFI on June 24, 2009, in force since Jan. 1. 2011 (RO 2009 3527 6849 ch. I).
RS 832.10 art. 9Facturation the services defined in art. 7, al. 2, that are provided by nurses or nurses or by organizations help and care home must be charged according to their nature.
The services defined in art. 7, al. 2, that are provided in medico-social institutions must be charged according to the need for care.

New content according to chapter I of O of the DFI on June 24, 2009, in force since Jan. 1. 2011 (RO 2009 3527 6849 ch. I).

Art. 9 introduced by section I of O the DFI seven 18. 1997 (RO 1997 2436). Repealed by no I of O of the DFI on June 24, 2009, with effect from Jan 1. 2011 (RO 2009 3527 6849 ch. I).

Section nutritional 3aConseils art. 9B dieticians and dietetic organisations, to the senses of the art. 46, 50 and 52b OAMal, provide, on prescription or medical term, dietary advice to policyholders who have the following diseases: a. metabolism disorders; b. obesity (BMI over 30 index) and conditions arising from excess weight or associated; b. obesity and overweight in "individual therapy multiprofessional structured ambulatory care for children and adolescents overweight or obesity with" according to annex 1 , ch. 4; c. cardiovascular disease; d. System Diseases Digestive; e. illnesses of kidneys; f. States of malnutrition or undernutrition; g. allergies or allergic reactions to food.

Insurance supports, on prescription of the doctor, at least six sessions of nutritional advice. The prescription may be renewed if new sessions are necessary.
If the nutritional advice should be pursued at the expense of insurance after 12 sessions, the physician refer to the medical consultant; It passes a duly reasoned proposal on the continuation of the nutritional advice. The medical consultant offers to the insurer to continue or not nutritional counselling at the expense of insurance, indicating to what extent.

Formerly art. 9. new content according to section I of the O of the DFI on October 16. in force since Jan. 1, 2012. 2013 (2012 5829 RO).
New content according to section I of the O of the DFI on Nov. 18. 1998, in force since Jan. 1. 1999 (RO 1999 528).
New content according to section I of the O of the DFI on Dec. 6. in force since Jan. 1, 2013. 2014 (2013 5329 RO).
Introduced by chapter I of O of the DFI on Dec 6. in force since Jan. 1, 2013. 2014 (2013 5329 RO).

Section 3bConseils to diabetics art. 9 c insurance supports the cost of advice to diabetics who are provided on prescription or medical mandate, by:

a. the nurses and nurses (art. 49 OAMal) who have special training recognized by the Swiss Association of nurses (ASI); b. an advice centre of the Swiss Association of diabetes admitted in application of art. 51 OAMal employing personnel graduated with special training recognized by ASI.

Tips for diabetics include advice and instructions on all aspects of care for the treatment of the disease (Diabetes mellitus).
Insurance is supported by medical prescription at most ten sessions of advice costs. For that, after ten sessions, they continue to be supported, the attending physician must submit a report to the medical officer of the insurer and provide a duly motivated proposal. The medical officer proposes to continue or not the advice at the expense of insurance, indicating to what extent.
Dieticians (art. 50A OAMal) employed in a Diabetes Association advice centre can provide the benefits contained in art. 9b, al. 1, let. a, as well as paras. 2 and 3.

New content according to section I of the O of the DFI on Dec. 9. 2002, in force since Jan. 1. 2003 (RO 2002 4253).

Section 4 speech therapy-speech therapy art. 10 principle speech therapists-speech therapists treat patients with disorders of language and speech, articulation, on medical prescription, the voice or the debit having one of the following causes: a. affect brain organic by infection, trauma, such as post-operative sequelae, by intoxication, tumor or vascular disorders; b. phoniatriques disorders (for example labio-maxillo-palatine malformation, partial or total; alteration of bucco-linguo-facial mobility or the soft palate of infectious or traumatic origin or as post-operative sequelae; dysphonia) hypo - or hyperfonctionnelle; alteration of the function of the larynx as post-operative sequelae or infectious or traumatic origin).

Art. 11 terms insurance is supported by medical prescription, at least twelve logopedic therapy sessions, in a period of maximum three months the medical prescription.
A new prescription is needed for the support of a greater number of sessions.
If logopedic therapy should be pursued at the expense of insurance after a treatment equivalent to 60 hour sessions in a period of one year, the doctor refer to medical consultant; It passes a duly reasoned proposal on the continuation of therapy. The medical officer proposes to continue or not the therapy at the expense of insurance, indicating to what extent.
The treating physician addressing the doctor Council a report in respect to the treatment and indication of the therapy at least once per year.
Reports to the medical consultant, application of paras. 3 and 4, only contain the information necessary to establish whether the treatment will continue to be supported by the insurer.

New content of the sentence according to section I of the O of the DFI on Dec. 13. 1996, in force since Jan. 1. 1997 (RO 1997 564).

Chapter 3 prevention measures art. 12Principe insurance supports following preventive medical measures (art. 26 KVG): a. prophylactic Vaccinations (art. 12A); b. measures for prophylaxis of diseases (art. 12b); c. review general health status (art. 12); d. measures of early detection of disease in some groups at risk (art. 12d); e. measures of early detection of diseases in the population. also make party measures that apply to all people of a certain age men or women (art. 12) only.

New content according to section I of the O of the DFI on Nov. 21. 2007, in force since Jan. 1. 2008 (2007 6839 RO).
RS 832.10 art. prophylactic 12aVaccinations insurance supports the following prophylactic vaccinations to the following costs: measurement Conditions a. Vaccination and reminders against diphtheria, tetanus, pertussis and polio. vaccination against measles, mumps and rubella according to the 'Swiss vaccination Plan 2015' (vaccination Plan 2015) established by the federal Office of health public (FOPH) and the Federal Commission for 1.1.2013 to 31.12.2015 vaccinations (CFV), no deductible is levied for vaccination against measles, mumps and rubella to those born after the 31.12.1963.

(b) Vaccination against Haemophilus influenzae for children up to the age of five, according to the vaccination 2015 Plan.

c. Vaccination against influenza 1. Annual vaccination for people with high-risk of complications; According to the vaccination Plan 2015.2. In case of threat of pandemic influenza or an influenza pandemic, for people for whom the FOPH recommended vaccination (in accordance with article 12 of the O of April 27, 2005 on pandemic influenza). No deductible is charged for this service. A lump sum is given to vaccination (including vaccine).

d. Vaccination against hepatitis B 1. For newborns of HBsAg-positive mothers and people exposed to a risk of contamination. If professional, vaccination is not supported by insurance.
2 vaccination according to the recommendations established in 1997 by the FOPH and the VFC (Supplement of the FOPH Bulletin 5/98 and supplement of the Bulletin 36/98) and according to the vaccination 2015 Plan.

e. passive immunization with hepatitis B - immunoglobulin for newborns of HbsAg-positive mothers.

f. Vaccination against pneumococci 1. According to the vaccination Plan 2015.2. Costs are supported only for vaccination using vaccines authorised for the relevant age group.

g. Vaccination against the meningococcal vaccination 2015 plan.
Costs are supported only for vaccination using vaccines authorised for the relevant age group.
In case of professional indication and medical recommendation to travellers, vaccination is not supported by insurance.

h. Vaccination against tuberculosis with the BCG vaccine, according to the vaccination 2015 Plan.

i. Vaccination against TBE (FSME) according to the vaccination 2015 Plan.
If professional, vaccination is not supported by insurance.

j. Vaccination against chickenpox vaccination 2015 plan.

k. Vaccination against human papillomavirus (HPV) 1. According to the recommendations of the FOPH and the June 2007 CFV (Bulletin of the FOPH 25 2007): a. vaccination General of school age girls;
(b) vaccination of girls and young women from 15 to 26 years. This provision shall apply until 31 December 2017.
2 vaccination cantonal programs of vaccination which must meet the following minimum requirements: a. the information of the target groups and their parents/guardians about the availability of vaccines and the recommendations of the FOPH and the VFC is provided;
(b) the purchase of the vaccines is done centrally;
c. complete vaccination (schema of vaccination according to the recommendations of the FOPH and the VFC) is meant.
(d) the benefits and obligations of the program, doctors responsible for vaccination and health insurers are defined;
e. the collection of data, Countdown, informational and financial flows are resolved.
3. no deductible is levied on this service.

l. Vaccination against hepatitis a. vaccination 2015 plan
For the following persons: - for patients with a chronic condition of the liver; - for children from countries with strong or medium endemic who live in Switzerland and return to their country of origin for a temporary stay; - for injection drug users; - for men who have sex with other men outside a stable relationship.

Post-expositionnelle vaccination within seven days after exposure.
In case of professional indication and medical recommendation to travellers, vaccination is not supported by insurance.

Mr. vaccination against rabies Vaccination post-expositionnelle, after a bite by a rabid or animal likely to be.
If professional vaccination is not supported by insurance.

Introduced by section I of O of the DFI of Nov. 21. 2007 (2007 6839 RO). New content according to chapter I of O of the DFI on June 10, 2013, in force since July 1. 2013 (2013 1925 RO).
New content according to chapter I of O of the DFI on May 16, 2014, in force since July 1. 2014 (2014 1251 RO).
New expression according to section I of the O of the DFI on 17 June 2015, in force since July 15. 2015 (2015 2197 RO). This mod has been taken throughout the text. The document can be accessed at the following address: www.ofsp.admin.ch > Themes > health insurance > enforcement and legal basis > law > Documents of reference related to the ASD and its annexes.
New content according to chapter I of O of the DFI on May 16, 2014, in force since July 1. 2014 (2014 1251 RO).
New content according to section I of the O of the DFI on Nov. 20. in force since Jan. 1, 2014. 2015 (2014 4393 RO).
RS 818.101.23 introduced by chapter I of the O of the DFI on June 10, 2013 (2013 RO, 1925). New content according to chapter I of O of the DFI on May 16, 2014, in force since July 1. 2014 (2014 1251 RO).

The document can be accessed at the following address: www.bag.admin.ch/ref the document can be accessed at the following address: www.bag.admin.ch/ref new content according to section I of the O of the DFI on Nov. 20. in force since Jan. 1, 2014. 2015 (2014 4393 RO).
New content according to chapter I of O of the DFI on May 16, 2014, in force since July 1. 2014 (2014 1251 RO).
New content according to section I of the O of the DFI on Nov. 20. in force since Jan. 1, 2014. 2015 (2014 4393 RO).
New content according to chapter I of O of the DFI on May 16, 2014, in force since July 1. 2014 (2014 1251 RO).
New content according to chapter I of O of the DFI on May 16, 2014, in force since July 1. 2014 (2014 1251 RO).
The document can be accessed at the following address: www.bag.admin.ch/ref new content according to chapter I of O of the DFI on May 16, 2014, in force since July 1. 2014 (2014 1251 RO).

Art. 12bMesures for the prophylaxis of diseases the insurance covers costs of the following diseases prophylaxis to the following conditions: measurement Conditions a. prophylaxis with vitamin K in newborns (3 doses).

b. Prevention of rickets to vitamin D in children during their first year.

c. HIV prophylaxis post-exposure according to the recommendations of the FOPH on 24 November 2014 (Bulletin of the FOPH n 48, 2014).
If professional, vaccination is not supported by insurance.

d. passive immunization post-expositionnelle according to the recommendations of the FOPH and the Swiss Commission for vaccinations (guidelines and recommendations "Post-expositionnelle passive immunization" October 2004).
If professional, vaccination is not supported by insurance.

e. mastectomy and / or adnexectomie prophylactic in carriers of BRCA1 or BRCA2 gene.

Introduced by section I of O of the DFI of Nov. 21. 2007, in force since Jan. 1. 2008 (2007 6839 RO).
Introduced by chapter I of the O of the DFI on June 5, 2009 (RO 2009 2821). New content according to section I of the O of the DFI on Nov. 20. in force since Jan. 1, 2014. 2015 (2014 4393 RO).
The document can be accessed at the following address: www.bag.admin.ch/ref introduced by chapter I of the O of the DFI on June 5, 2009 (RO 2009 2821). New content according to chapter I of O of the DFI on May 31, 2011, in force since July 1. 2011 (2011 2669 RO).
The document can be accessed at the following address: www.bag.admin.ch/ref introduced by chapter I of O of the DFI on Dec. 5. 2011, in force since Jan. 1. 2012 (2011 6487 RO).

Art. 12cExamens about the State of general health insurance supports the costs of the following about the general State of health in the following terms: measurement Conditions a. review of good health and development of children of pre-school age according to the recommendations of the Manual: "Screening tests", published by the Swiss Paediatric Society (2 edition, Bern, 1993); in total: eight reviews.

Introduced by section I of O of the DFI of Nov. 21. 2007, in force since Jan. 1. 2008 (2007 6839 RO).

Art. 12dMesures with a view to the early detection of disease in certain groups at risk insurance supports the costs of the following measures with a view to the early detection of disease in certain groups at risk to the conditions below: measurement Conditions a. HIV Test for infants of HIV-positive mothers.
For other people, according to the directive of the FOPH "HIV testing carried out on the initiative of doctors in the presence of certain pathologies (evocative diseases of HIV infection)" on November 18, 2013.

b. colonoscopy in colon cancer family (at least three parents of first degree attained) or a before the age of 30.

c. review of the skin in case of high risk of family Melanoma (melanoma in a first degree relative).

d. 1 breast MRI, digital mammography. For women with a risk moderate or high of breast cancer because of family history or comparable personal history. Designation of the risk according to the reference document of the FOPH 'Risk assessment' (State 2/2015). To determine if the risk is high, genetic counseling within the meaning of the let. f must be made. Indication, frequency and method of analysis tailored based on risk and age, according to the reference document of the FOPH "Monitoring Schema" (State 2/2015). Explanatory and Council maintenance must precede the first review and be recorded.
2... e. contracture Test muscle in vitro on detection of a predisposition to malignant hyperthermia in people having presented an episode during anesthesia leaving suspect a malignant hyperthermia and at consanguineous relatives to the first degree of the people for whom a malignant hyperthermia under anesthesia is known and a predisposition for malignant hyperthermia is documented.
In a Center recognized by the European Malignant Hyperthermia Group.

f. genetic counseling, installation of indication for genetic analysis and prescription of laboratory related in accordance with the list of analyses (THE) suspicion of predisposition to hereditary cancer patients and their parents in the first degree with: - a hereditary breast or ovarian cancer syndrome - a colonic polyposis or form attenuated colonic polyposis - colorectal cancer without polyposis (HNPCC syndrome hereditary syndrome (, not polypotic colon cancer hereditary)-a retinoblastoma.

By doctors specialized in medical genetics or by members of the "Network for Cancer Predisposition Testing and Counseling" Swiss group for clinical cancer research (SAKK) who can prove their technical collaboration with a doctor who specializes in medical genetics.

If the attribution to a risk group is based on a degree of kinship with one or more sick people, it is determined on the anamnestic data base in the bio-medical sense.

Introduced by section I of O of the DFI of Nov. 21. 2007, in force since Jan. 1. 2008 (2007 6839 RO).
New content according to chapter I of O of the DFI on 17 June 2015, in effect since July 15. 2015 (2015 2197 RO).
The document can be accessed at the following address: www.ofsp.admin.ch > Themes > health insurance > enforcement and legal basis > law > Documents of reference related to the ASD and its annexes.
New content according to chapter I of O of the DFI on 17 June 2015, in effect since July 15. 2015, except no. 2, in force since Jan. 1. 2017 (2015 2197 RO).
The document can be accessed at the following address: www.ofsp.admin.ch > Themes > health insurance > enforcement and legal basis > law > Documents of reference related to the ASD and its annexes.
The document can be accessed at the following address: www.ofsp.admin.ch > Themes > health insurance > enforcement and legal basis > law > Documents of reference related to the ASD and its annexes.
New content according to section I of the O of the DFI on Dec. 5. 2011, in force since Jan. 1. 2012 (2011 6487 RO).
Introduced by chapter I of the O of the DFI on 17 June 2015, in force since 15 July. 2015 (2015 2197 RO).

Art. 12eMesures of early detection of diseases throughout the insurance population supports the costs of the following measures with a view to the early detection of diseases in the population to the conditions below: measurement Conditions a. screening of: phenylketonuria, galactosemia, deficit in biotinidase, syndrome adrenogenital, congenital hypothyroidism, deficit in acyl-CoA medium-chain-dehydrogenase (MCAD), cystic fibrosis.

For newborns.
Laboratory according to the list of analyses (LA).

b. gynecological examination, including head and neck-vaginal cytologic screening samples the first two years: a review by year, including cytological screening samples. Later, when the results are normal, a review every three years. If frequency of examinations according to clinical evaluation.

(c) mammography screening from the age of 50 years old, every two years as part of an organized screening program of the breast cancer who meets the conditions set by the order of 23 June 1999 on the quality assurance of screening programs of the breast by mammograms. No deductible is levied on this service.

d. the age range of 50 to 69 years methods colon cancer screening:-analysis to detect the presence of occult blood in the stool, every two years, according to the list of analyses laboratory (LA), colonoscopy in case of positive result, or - colonoscopy every 10 years.

If the analysis is part of the Vaud Cantonal programs or URI, no deductible is charged on delivery.

Introduced by section I of O of the DFI of Nov. 21. 2007, in force since Jan. 1. 2008 (2007 6839 RO).
New content according to section I of the O of the DFI on Dec. 6. in force since Jan. 1, 2013. 2014 (2013 5329 RO).
New content according to section I of the O of the DFI from nov 27. 2015, in force since Jan. 1. 2016 (2015 5125 RO).
RS 832.102.4 new content according to chapter I of O of the DFI on May 16, 2014, in force since July 1. 2014 (2014 1251 RO).

Chapter 4 specific benefits in case of maternity art. 13 examinations insurance supports, maternity, the following control (art. 29, para. 2, let. a, KVG): measure Conditions a. controls 1. during a normal pregnancy seven reviews


-first consultation: anamnesis, clinical and gynecological exam advice, and General review of the veins and research of oedema of the legs; prescription of the necessary laboratory tests in accordance with the list of analyses (THE);-further consultations: weight, blood pressure control, the height of the uterus, urinary examination and auscultation of the heart sounds fetal; prescription of the necessary laboratory tests in accordance with the list of analyses (LA).

2. in the case of a high-risk pregnancy exams according to the clinical evaluation renewal b. controls ultrasonographiques 1. during a normal pregnancy: an ultrasound between 12 and 14 weeks of pregnancy; an ultrasound between 20 and 23 weeks of pregnancy.

After an interview in-depth explanation and Council who shall be recorded.
According to the "recommendations for the ultrasound examinations during pregnancy', the company Swiss of ultrasound in medicine (SSUM), section Gynecology and obstetrics, 3rd edition (2011).
Only by physicians with additional training in prenatal ultrasonography (SSUM) certificate.
Only by physicians with additional training in prenatal ultrasonography (SSUM) certificate.

2. in the case of a high-risk pregnancy (AFC) renewal of tests according to the clinical evaluation only by doctors with certificate of training ongoing prenatal ultrasonography.

b. the Q1 test prenatal analysis of the risk of trisomy 21, 18 and 13: measuring clarity neck by ultrasound (between the 12 and 14 week), by dosage of the free fraction of beta-hCG and PAPP-A in the mother's blood, on the basis of other factors related to the fetus and the mother.
Information in accordance with art. 16 and respect for the right to self-determination in the sense of art. 18 of the Federal Act of 8 October 2004 on human genetic analysis (LAGH).
Prescription only by doctors with certificate of training in prenatal ultrasonography of the SSUM and complementary certification for the measurement of neck clarity.
Measure the neck clarity only by physicians with additional training in prenatal ultrasonography (SSUM) certificate.
Laboratory according to the list of analyses (LA).

b. test non-invasive prenatal diagnosis (DPNI) only to detect a trisomy 21, 18 or 13 in a single pregnancy.
From the 12 week of pregnancy.
For women whose test of the first quarter indicates a risk of 1: 1000 or more that the fetus is reached a trisomy 21, 18 or 13.
After an explanatory interview and Council in accordance with the art. 14 and 15 LAGH and after obtaining the written consent of the pregnant woman, in respect of its right to self-determination in the sense of art. 18 LAGH.
Prescription only by specialists in gynaecology and obstetrics with extensive training in medicine foeto-kindergarten, by specialists in medical genetics or by doctors with certificate of training in ultrasound prenatal the SSUM.
Laboratory according to the list of analyses (LA).
If the sex of the fetus is determined for technical reasons, this information cannot be disclosed before the end of the 12 weeks of amenorrhea.
Management of costs is limited to 30 June 2017.

c. review pre-partum through the cardiotocography during a high-risk pregnancy d. amniocentesis, removal of the villi CVS, Cordocentesis after an in-depth interview which shall be recorded in the following cases:-to confirm a positive result in pregnant women, including prenatal diagnosis test invasive (DPNI) suggests strongly that the fetus has a trisomy 21 18 or 13 or the test of the first quarter shows that they present a risk of 1:380 or more that the fetus be reached such a disease; - for women in which the result of ultrasound, family history or any other reason suggests a risk of 1:380 or more that the fetus is have a disease due to exclusively genetic factors; - in the event of danger to the fetus by a complication a disease of the pregnant woman, a disease that is not caused by genetic factors or by the fetal development disorders;

Prescription of DNA only by specialists in gynaecology and obstetrics with extensive training in medicine foeto-kindergarten, by specialists in medical genetics or by doctors with certificate of training in ultrasound prenatal the SSUM.
-According to the list of analyses laboratory analysis (LA).

e. Control postpartum a review between the sixth and tenth week postpartum: intermediate anamnesis, gynecological and clinical status including the provision of advice.

RS 832.10 new content according to section I of the O of the DFI on Dec. 10. 2008, in force since Jan. 1. 2009 (RO 2008 6493).
New content according to chapter I of the O of the DFI on June 26, 2008, in force since August 1, 2008 (RO 2008 3553).
New content according to section I of the O of the DFI from nov 27. 2015, in force since Jan. 1. 2016 (2015 5125 RO).
The document can be accessed at the following address: www.bag.admin.ch/ref introduced by chapter I of the O of the DFI on 17 June 2015 (RO 2015 2197). New content according to section I of the O of the DFI from nov 27. 2015, in force since Jan. 1. 2016 (2015 5125 RO).
RS 810.12 introduced by section I of O of the DFI on 17 June 2015, in force since July 15. 2015 (2015 2197 RO).
Erratum of 15 sept. 2015 (2015 3147 RO).
New content according to chapter I of the O of the DFI on June 26, 2008, in force since August 1, 2008 (RO 2008 3553).
New content according to chapter I of O of the DFI on 17 June 2015, in effect since July 15. 2015 (2015 2197 RO). Erratum of 15 sept. 2015 (2015 3147 RO).

Art. 14preparation childbirth insurance supports a contribution of 150 francs for an individual course or group of preparation to delivery by a midwife.

New content according to chapter I of O of the DFI on 17 June 2015, in effect since July 15. 2015 (2015 2197 RO).

Art. 15 Tips breastfeeding advice on breast-feeding (art. 29, para. 2, let. c, KVG) are the responsibility of the insurance when they are provided by a midwife or a nurse with special training in this area.
The refund is limited to three sessions.

RS 832.10 new content according to section I of the O of the DFI on Dec. 5. 2011, in force since Jan. 1. 2012 (2011 6487 RO).

Art. 16Prestations midwives midwives can perform the responsibility of insurance the following services: a. services defined in art. 13, let. a: 1. during a normal pregnancy, the midwife can perform six examinations; She is required to report to the insured that a doctor is indicated before the 16 weeks of pregnancy, 2. during a pregnancy risk without pathological manifestation, the midwife works with the doctor; in a pathological pregnancy, the midwife performs its services according to the medical prescription.

(b) the prescription, in a review of control, ultrasonic control mentioned in art. 13, let. b.c. benefits defined in art. 13, let. c and e, as well as the art. 14 and 15; d. a follow-up, 56 days after the birth, consisting of home visits to monitor the State of health of the mother and the child and provide care as well as to support, guide and advise the mother in how to take care of the child and to feed him: 1. Sixteen home visits to the in case of premature birth multiple birth of first child or c-section or ten home visits at the most in any other case, 2. during the 10 days following the birth, the midwife may, in addition to the visits to home according to section 1, organize a second visit on the same day, to a maximum of five times, 3. a medical prescription is required for home visits, additional to those referred to in points 1 and 2.

Midwives can prescribe necessary laboratory analyses, for the services referred to in art. 13, let. a and e, according to a separate designation in the list of tests (THE).


New content according to section I of the O of the DFI on Dec. 10. 2008, in force since Jan. 1. 2009 (RO 2008 6493).
Introduced by chapter I of the O of the DFI on 17 June 2015, in force since 15 July. 2015 (2015 2197 RO).
New content according to section I of the O of the DFI from nov 27. 2015, in force since Jan. 1. 2016 (2015 5125 RO).
New content according to section I of the O of the DFI from nov 27. 2015, in force since Jan. 1. 2016 (2015 5125 RO).
Repealed by no I of O of the DFI on 17 June 2015, with effect from 15 July. 2015 (2015 2197 RO).

Chapter 5 care dental art. 17 diseases of the mastication system provided that the condition may be described as a disease and treatment being taken in charge by the insurance insofar as the treatment of the condition requires it, the insurance covers dental care caused by the illness and not avoidable following of the mastication system (art. 31, para. 1, let. has) (KVG): a. dental diseases: dental 1 Granuloma internal idiopathic, 2 dental dislocations, teeth or supernumerary dental germs, which can be classified as disease (for example: abscess, cyst);

b. diseases of the system of support of the tooth (parodontopathies):

1 periodontitis pre pubertal, 2. progressive juvenile periodontitis: 3. irreversible side effects of drugs;

c. the jaw bone and soft tissue diseases: 1. benign tumors of the jaws and mucous and pseudotumorales changes, 2. malignant tumors of the face, the maxillary and neck, 3. the maxillary osteopathies, 4 cysts (unrelated to a dental element), 5. osteomyelitis of the jaws;

d. the temporomandibular joint and locomotion apparatus diseases: 1 osteoarthritis of the temporomandibular joint, 2 ankylosis, 3 dislocation of condyle and articular disk;

e. the maxillary sinus disease: 1 tooth or tooth fragment lodged in the sinus, 2 oral sinus fistula;

f. dysgnathies which cause disorders that can be classified as disease, such as: 1. syndrome of the sleep apnea, 2 serious problems with swallowing, 3. severe cranio-facial asymmetries.

RS 832.10 art. 18. other diseases insurance supports dental care incurred by the following other serious diseases or their sequelae and necessary for their treatment (art. 31, para. 1, let b, KVG): a. diseases of the hematopoietic system: 1 neutropenia, agranulocytosis, 2 severe aplastic anemia, leukemia 3, 4 syndromes (MDS) myelodysplastiques, 5. bleeding bleeding;

b. diseases of the metabolism: 1 acromegaly, hyperparathyroidism 2, 3 idiopathic hypoparathyroidism, 4 hypophosphatasia (genetic rickets due to vitamin D resistance);

c. other diseases: 1 Chronic Polyarthritis with achievement of the maxillary, 2 disease Bekhterev with achievement of the maxillary, 3 with achievement of the maxillary psoriatic arthropathy, 4 disease of butterfly-Lefèvre, 5 Scleroderma, 6 AIDS, 7. psychic diseases with a serious of chewing function consecutive attack;

d. diseases of glands salivary; e....

The services referred to in para. 1 are supported only if health insurance previously gave a special guarantee and with the express permission of the medical officer.

New content according to chapter I of the O of the DFI from 9 July. 1998, in force since Jan. 1. 1999 (RO 1998 2923).
RS 832.10 new content according to chapter I of the O of the DFI from 9 July. 1998, in force since Jan. 1. 1999 (RO 1998 2923).
Repealed by section I of O of the DFI on 9 July. with effect from Jan 1, 1998. 1999 (RO 1998 2923).
Introduced by chapter I of O of the DFI on 2 July. 2002, in force since July 1. 2002 (RO 2002 3013, 2005 5021).

Art. 19Soins dental insurance supports the necessary dental care to achieve and ensure medical treatment (art. 31, al. 1, let c, KVG): a. during the replacement of heart valves, implantation of prostheses of revascularization or head shunt; b. during interventions that will require a long-term immuno-suppressor treatment; c. during radiation treatment or chemotherapy for malignant disease; d. at endocarditis; (e) in the case of the sleep apnea syndrome.

New content according to chapter I of the O of the DFI from 9 July. 1998, in force since Jan. 1. 1999 (RO 1998 2923).
New content according to chapter I of O of the DFI on May 16, 2014, in force since July 1. 2014 (2014 1251 RO).
RS 832.10 introduced by section I of O of the DFI on May 16, 2014, in effect since July 1. 2014 (2014 1251 RO).

Art. congenital 19ainfirmites insurance supports the costs of dental treatment caused by congenital disabilities, within the meaning of para. 2, when: a. treatments are necessary after the 20 year; b. treatments are necessary before the 20 year for an insured under the health insurance act but who is not insured by the federal disability insurance.

Congenital disabilities, within the meaning of para. 1, are: 1 Dysplasias Ectodermal; 2. Bullous congenital skin diseases (Epidermolysis Bullosa hereditary, Acrodermatitis enteropathic and family benign chronic pemphigus); 3. chondrodystrophy (e.g.: Achondroplasia, hypochondroplasie, multiple epiphyseal dysplasia); 4. Dysostoses congenital; 5. Exostoses cartilaginous, when an operation is necessary; 6. hemihypertrophies and other bodily asymmetries congenital, when an operation is necessary; 7. congenital deficiencies of the skull; 8. craniosynostosis; 9. congenital spinal malformations (vertebrae highly Cuneiform, welded block vertebrae type Klippel-Feil, aplasiques vertebrates and vertebrates very highly Dysplastic); 10. congenital arthromyodysplasie (arthrogryposis); 11. progressive muscular dystrophy and other myopathies congenital; 12. Myositis ossifiante progressive congenital; 13. cheilo-gnatho-palatoschisis (crack lips, maxillary, palatine division); 14. facial, median, oblique and transverse; 15 cracks. defects of the nose and lips; 16 fistulas. proboscis lateralis;
17 dental dysplasia congenital, when at least twelve teeth of the second dentition after eruption are strongly affected and is expected to treat them permanently by the laying of wreaths; 18. anodontie congenital total or partial congenital anodontie by lack of at least two permanent teeth juxtaposed or four permanent teeth per jaw excluding wisdom teeth; 19. hyperodontie congenital, when the supernumerary teeth cause a deviation intramaxillaire or intramandibulaire that requires a treatment using devices; 20. congenital micromandibulie lower, where it results, in the first year of life, trouble swallowing and respiration requiring treatment or when:-the cephalometric assessment shows a divergence of sagittal reports of the jaw measured by 9 degrees and over ANB angle (or an ANB to at least 7 degrees angle combined with a maxillo-basal angle of 37 degrees); - permanent teeth excluding wisdom teeth, present a non-occlusion of at least three pairs of opposing teeth in the lateral segments by half of jaw;

21 mordex apertus congenital, when it causes a vertical gap after the permanent incisors erupt and the cephalometric assessment shows a maxillo-basal angle of 40 degrees and more (or 37 degrees to the less combined at an angle of 7 degrees ANB and more); mordex clausus congenital, when it results in a supraclusie after the permanent incisors erupt and the cephalometric assessment shows a maxillo-basal angle of 12 degrees at most (or 15 degrees to more combined with an ANB angle of) 7 degrees and more);
22. congenital, when lower prognathism: - the cephalometric assessment shows a divergence of sagittal reports of the jaw measured by an at least-1 degree ANB angle and that at least two opposing pairs of the second dentition are in position of crossbite or end to end, - there is a difference of + 1 degree combined with a maxillo-basal angle of 37 degrees and more , or 15 degrees at most.

23 epulis of the newborn; 24. atresia of the choanae; 25. glossoschisis; 26. MACROGLOSSIA, congenital, when a language is necessary; 27 and microglossie. congenital cysts and tumors congenital language; 28. congenital disorders of the salivary glands and their excretory channels (fistulas, strictures, cysts, tumors, ectasies and hypo - or all of the major salivary glands prca);
28. retention or ankylosis is congenital teeth when several molars at least two premolars or molars of the second dentition placed next to each other (except wisdom teeth) are affected, the absence of teeth (except wisdom teeth) is treated in the same way as the retention or ankylosis;

29 cysts congenital neck, fistulas and congenital cervical slots and congenital tumors (Reichert cartilage); 30. Hemangioma cavernous or tuberous; 31. lymphangiome congenital, when an operation is necessary; 32. coagulopathies and thrombocytopathies congenital; 33. histiocytoses (EE Granuloma, Hand - Schuler - Christian and Letterer - Siwe Disease) 34. malformations of the nervous system and its envelopes (encephalocele, arachnoid cyst, myelomeningocele, hydromyelie, meningocele, megalencephalie, porencephaly and diastematomyelie); 35. heredo-degenerative disorders of the nervous system (e.g.: ataxia, leukodystrophies, and progressive disorders of the grey matter, muscle atrophies of spinal or neural origin, Dysautonomia, congenital analgesia); 36. Epilepsies congenital; 37. congenital brain paralysis (spastic, athetosiques and ataxic); 38. paralysis and congenital; 39 pareses. 40; congenital eyelid PTOSIS. Aplasia of lacrimal; 41 channels. anophthalmie; 42. congenital tumors of orbital; 43 cavity. atresia congenital ear, including the malformation and the microtia; 44. birth defects of the skeleton of the ear; 45. congenital disorders of the metabolism of the mucopolysaccharides and glycoproteins (e.g.: illness Pfaundler-scream, Morquio disease); 46. congenital disorders of the metabolism of the bone (e.g.: hypophosphatasia, progressive diaphyseal Dysplasia of Camurati-Engelmann, osteoarthrosis of Lichtenstein Jaffé, rickets resistant to treatment with vitamin D); 47. congenital disorders of the thyroid gland function (athyroide, hypothyroid and cretinism); 48. disorders congenital function hypothalamohypophysaire (pituitary dwarfism, diabetes insipidus, Kallmann syndrome and Prader-Willi syndrome); 49. disorders congenital to the function of the gonads (Turner, malformations of ovaries, anorchie syndrome), Klinefelter syndrome; 50. Neurofibromatosis, 51. angiomatose EEG-trigenimee (Sturge-Weber-Krabbe); 52. congenital dystrophy of connective tissue (e.g.: syndrome of Marfan, Ehlers-Danlos syndrome, cutis laxa congenita, elastic pseudoxanthome); 53. teratomas and other germ cell tumors (e.g.: dysgerminome, embryonic Carcinoma, mixed germ cell tumor, SAC tumor, choriocarcinoma, gonadoblastoma).

Introduced by chapter I of O of the DFI on 13 Dec. 1996, in force since Jan. 1. 1997 (RO 1997 564).
New content according to chapter I of the O of the DFI from 4 July. 1997, in force since Jan. 1. 1998 (RO 1997 2697).
RS 832.10 new content according to chapter I of the O of the DFI from 9 July. 1998, in force since Jan. 1. 1998 (RO 1998 2923).
New content according to chapter I of the O of the DFI from 9 July. 1998, in force since Jan. 1. 1998 (RO 1998 2923).
New content according to chapter I of the O of the DFI from 9 July. 2001, in force since the Jan. 2001 (RO 2001 2150).
Introduced by chapter I of O of the DFI on 9 July. 1998 (RO 1998 2923). New content according to chapter I of the O of the DFI from 9 July. 2001, in force since the Jan. 2001 (RO 2001 2150).

Chapter 6 and devices diagnostic or therapeutic art. 20Principe insurance grants a refund for means and therapeutic devices or Diagnostics to monitor the treatment of a disease and its consequences, delivered on prescription by a health club in the sense of art. 55 OAMal and used by the insured person himself or with the help of a non-professional player involved in the examination or treatment.

New content according to chapter I of the O of the DFI on June 28, 2007, in force since August 1, 2007 (RO 2007 3581).

Art. 20aListe of the ways and means and devices are listed in Schedule 2 by nature and by product group.
The means and devices that are implanted in the body or that are used by service providers practicing in the charge of the mandatory healthcare insurance under art. 35, al. 2, KVG are not on the list. The refund is fixed in the tariff agreements with the review or the corresponding treatment.
The list of the means and devices is not published to the official federal law (RO) collection or the systematic collection of federal law (RS). The changes are posted online on the website of the FOPH. A global list is published in principle once a year.

Introduced by chapter I of the O of the DFI on June 28, 2007, in force since August 1, 2007 (RO 2007 3581).
RS 832.10 HYPERLINK "http://www.bag.admin.ch" > Themes > health insurance > prices > list of means and devices list can be obtained from the federal Office of constructions and logistics (FBL), sale of federal publications, 3003 Bern new content according to section I of the O of the DFI 5 dec. 2011, in force since Jan. 1. 2012 (2011 6487 RO).

Art. 21Annonce requests which are intended the admission of new means and devices on the list or the amount of the refund must be sent to the FOPH. The FOPH reviews each application and presents it to the Federal Commission of analysis, means and devices.

New content according to chapter I of O of the DFI on June 28, 2007, in force since Jan. 1. 2008 (2007 3581 RO).

Art. 22 limiting conditions admission on the list may be subject to a restrictive condition. It can especially relate to the amount, the duration of use, the medical indication or age of the insured.

Art. 23 requirements can be delivered in the categories of AIDS and devices on the list, the products federal or cantonal legislation allows to put into circulation. Shall apply the law of the canton in which the fitness center is located.

Art. 24 refund the means and devices are reimbursed only up to the fixed amount of a way or a unit in the same class that is on the list.
When a product is invoiced by a fitness center for an amount greater than the one who is on the list, the difference is charged to the insured.
The amount of the refund may be the selling price or rental price. The means and expensive devices that can be reused by other patients are, as a general rule, rented.
Insurance supports only the costs of the means and devices, according to annex 2, delivered ready to use. When they are sold, a refund for the cost of maintenance and adjustment necessary can be expected on the list. Maintenance and adaptation costs are included in the rental price.

Chapter 7 Contributions to cure resort fees, transportation and rescue art. 25 participation in the costs of Spa cure insurance pays a participation of 10 francs per day of resort treatment prescribed by a doctor, for a maximum period of 21 days per calendar year.

Art. 26 contribution to costs of transport insurance supports 50% of the costs incurred by the medically indicated transportation to allow the delivery of care by a service provider, able to deal with the disease and part suppliers that the insured has the right to choose, when the State of the patient's health does not allow him to use another means of public transport or private. The maximum amount is CHF 500 per calendar year.
The transport must be carried out in a way that meets the medical requirements of the case.

Art. 27 the rescue cost insurance contribution supports 50% of the costs of rescue in Switzerland. The maximum is 5000 francs per calendar year.

Chapter 8 Analyses and drugs Section 1 list of analyses art. 28. the list referred to in art. 52, al. 1, let. a, point 1, LAMal, is part of this order, which represents Annex 3 titled "list of tests" ("LAna").
The list of tests is not published to the RO or the RS. The changes are posted online on the website of the FOPH. A global list is published in principle once a year.

New content according to chapter I of the O of the DFI from 3 July. 1996, in force since Oct. 1. 1996 (RO 1996 2430).
RS 832.10 new content according to chapter I of the O of the DFI from 10 July. 2000, in force since Jan. 1. 2001 (RO 2000 2546).
HYPERLINK "http://www.bag.admin.ch" > Themes > health insurance > prices > list of analyses the list can be obtained from the federal Office of constructions and logistics (FBL), sale of federal publications, 3003 Bern new content according to section I of the O of the DFI 5 dec. 2011, in force since Jan. 1. 2012 (2011 6487 RO).

Section 2 list of drugs with price art. 29. the list provided for in art. 52, al. 1, let. a, point 2, LAMal, is an integral part of this order as annex 4 with the title list of drugs with price (abbreviated "LMT").
The list of drugs with rate is not published in the official federal laws (RO) collection or the systematic collection of federal law (RS). She appears in principle once a year and can be ordered from the federal Office for buildings and logistics (FBL), sale of federal publications, 3003 Berne.

New content according to chapter I of O of the DFI on Feb 26. 1996, in force since June 1, 1996 (RO 1996 1232).
RS 832.10 drugs with price list can also be found either at the federal Office of public health, health insurance and accident, 3003 Bern, or at the Internet address: www.bag.admin.ch/themen/krankenversicherung/06492/06493/index.html?lang=fr

New content according to chapter I of the O of the DFI from 2 July. 2002, in force since July 1. 2002 (RO 2002 3013).

Section 3 list specialties art. 30 principle a drug may be admitted to the list of specialties: a. when the evidence of its effectiveness, its therapeutic value and its economic character is established; b. when authorized by the Swiss Institute for therapeutic products (Swissmedic).



New content according to chapter I of the O of the DFI from 2 July. 2002, in force since July 1. 2002 (RO 2002 3013).
New content according to section I of the O of the DFI from nov 27. 2000, in force since Jan. 1. 2001 (RO 2000 3088).
New content according to chapter I of O of the DFI from 29 Apr. 2015, in force since June 1, 2015 (RO 2015 1359).
Repealed by no II 2 of the O of the DFI on 26 oct. 2001, with effect from Jan 1. 2002 (RO 2001 3397).

Art. 30aDemande for admission apply for admission in the list of specialties must contain: a. the notice issued by Swissmedic specifying the permission that he intends to give as well as the indications and dosages will be allowed; b. the instructions intended for the medical profession, which has been provided to Swissmedic; (b) in the case of the original preparations which are protected by a patent numbers of patents and supplementary protection certificates , with the expiration date; c. If records approved in the countries concerned, the drug is already allowed abroad; d. the summary of literature on the clinical studies which has been provided to Swissmedic; e. the most important clinical studies; f. the prices of manufactures in all countries of reference referred to in art. 35, as well as the target price for the European Community; g....

The final version of the manual for the medical professions, indicating possible changes and the final target price for the European Community, must be provided at the same time as the authorisation decision and the certificate of approval.

Introduced by chapter I of O of the DFI on 2 July. 2002, in force since July 1. 2002 (RO 2002 3013). See also the disp. Trans. of the mod of March 21, 2012 the end of the text.
Introduced by chapter I of the O of the DFI on April 26, 2006, in force since May 10, 2006 (RO 2006 1757).
Repealed by section I of O of the DFI on May 8, 2013, with effect from June 1, 2013 (RO 2013 1357).

Art. 31procedure for admission the FOPH decides, after consulting with the Federal Commission of drugs (CFM): a. Requests for admission of a medicinal product in the list of specialties referred to in art. 30A; b. applications for price increase referred to in art. 67, al. 2, OAMal; c. applications and the consequences of the communications referred to in art. 65F OAMal.

He decided without consulting the CFM: a. Requests for admission of new dosage forms, new heights of packaging or new dosages for drugs that are already on the list of specialties, as far as the indications of the drug should not be changed; b. applications of drugs that have been the subject of an application for a second requesting to Swissmedic to the senses of the art. 12 of the law of 15 December 2000 on therapeutic products and including the original preparation is already on the list of specialties; c. Admission applications of medicines in co-marketing including basic preparation is already on the list of specialties.

He can check the CFM for applications for admission referred to in para. 2 if its opinion is of particular interest.
When it is consulted, the CFM will issue a recommendation.

New content according to chapter I of O of the DFI from 29 Apr. 2015, in force since June 1, 2015 (RO 2015 1359).
SR 812.21 art. fast 31aprocedure for admission if Swissmedic has accepted a quick procedure of authorization within the meaning of art. 5 of the Ordinance of 17 October 2001 on the drugs, the FOPH launched a fast admission procedure.
The holder of the authorization must have lodged an application with the FOPH no later than 30 days before the CFM session in which the application for authorization must be treated.

Introduced by chapter I of O of the DFI on 2 July. 2002 (RO 2002 3013). New content according to chapter I of O of the DFI from 29 Apr. 2015, in force since June 1, 2015 (RO 2015 1359).
SR 812.212.21 art. 31bduree of the admission procedure in the list of specialties if the conditions governing the introduction on the applications set out in art. 69, al. 4, OAMal are met prior to final approval by Swissmedic, the FOPH decide normally within 60 days of final approval.

Introduced by section I of O of the DFI on Apr. 29. 2015, in force since June 1, 2015 (RO 2015 1359).

Art. 32efficacite to judge the effectiveness of a drug, the FOPH is based on the documents who founded the permission granted by Swissmedic. It may require additional documents.

New content according to chapter I of the O of the DFI from 2 July. 2002, in force since July 1. 2002 (RO 2002 3013).

Art. Therapeutic 33Valeur therapeutic value of a drug as to its effects and its composition is examined from the point of view of clinico-pharmacological and dosage; the review also covers the side effects and danger of misuse.
To judge the therapeutic value of a drug, the FOPH is based on the documents who founded the permission granted by Swissmedic. It may require additional documents.

New content according to section I of the O of the DFI from nov 27. 2000, in force since Jan. 1. 2001 (RO 2000 3088).
New content according to chapter I of the O of the DFI from 2 July. 2002, in force since July 1. 2002 (RO 2002 3013).

Art. 34Comparaison therapeutic for judging the economic character of a drug on the basis of the comparison with other drugs (therapeutic comparison), the FOPH examines the following criteria: a. effectiveness compared to other drugs with the same indications or similar effects; (b) the cost of the drug by day or treatment compared to the cost of drugs whose directions are the same or similar effects.

Premium innovation referred to in art. 65b, al. 7, OAMal is granted for more than fifteen years.

New content according to chapter I of O of the DFI from 21 oct. 2015, in effect since Nov. 15. 2015 (2015 4189 RO).

Art. 34aAdmission of new dosage forms, new heights of packaging or new dosages for the affected applications to art. 31, al. 2, let. a, the economic character is assessed exclusively on the basis of a therapeutic comparison with dosage forms, sizes of packaging or dosages of the drug that are already on the list of specialties.

Introduced by chapter I of the O of the DFI on 21 oct. 2015, in effect since Nov. 15. 2015 (2015 4189 RO).

Art. 34aComparaison with prices charged abroad: country of reference and the comparison object the economic character is assessed on the basis of a comparison with the prices charged in Germany, to the Denmark, Britain, the Netherlands, in France, in Austria, in Belgium, in Finland and in Sweden. The comparison can be made with other countries with similar economic structures in the pharmaceutical field, as long as the price of manufactures, the cost for pharmacies or the wholesale price is public.
The comparison is a drug in the reference countries, regardless of the name, the holder of the authorization or the support in the country of reference, and independently of an influence of the Swiss holder on the factory price. The same drug, means the original preparations containing the same active substance and possessing the same galenic form.
The differences in the data between the Switzerland and the reference countries are not taken into account.

Formerly art. 34 a. introduced by section I of O of the DFI on 29 Apr. 2015, in force since June 1, 2015 (RO 2015 1359).

Art. 34bComparaison with prices charged abroad: margins of wholesalers and discount imposed on manufacturers when compared with prices charged abroad, following wholesale margins are deducted from the cost for pharmacies or wholesale in accordance with art. 65b, al. 3, OAMal: a. Denmark: 6.5% of the cost for pharmacies; b. Britain: 12.5% of the wholesale price; (c) Netherlands: 6.5% of the cost for pharmacies; d. Finland: 3% of the cost for pharmacies; e. Sweden: 2.7% of the cost for pharmacies.

When compared with prices charged abroad, the following discounts imposed on manufacturers in accordance with art. 65b, al. 4, are deducted from the factory price in Germany: 7% for the original preparations; b. 16 percent for generic drugs and original drugs whose patent has expired.

If the authorisation holder can prove that the amounts referred to in paras. 1 or 2 differ from the actual amount of the margin or discount, the actual amounts are deducted.

Introduced by section I of O of the DFI on Apr. 29. 2015, in force since June 1, 2015 (RO 2015 1359).

Art. 34cComparaison with prices charged abroad: calculation and communication of the price of factory of the country of reference


The holder of the authorisation shall inform the FOPH factory of the country of reference price. It does attest by the holder of the authorization in the country of reference, by a competent authority or competent association. The FOPH sets in directions critical sources of information if it is not possible to determine clearly the factory prices, cost for pharmacies or as the holder of the authorization or wholesale price refuses to provide concerned prices.
The price of manufactures in the country of reference is converted into Swiss francs at the average exchange rate over 12 months calculated by the FOPH.

Introduced by section I of O of the DFI on Apr. 29. 2015, in force since June 1, 2015 (RO 2015 1359).

Art. eligibility every three years 34dreexamen: subject matter of the review of the economic nature of the FOPH shall once per calendar year in the prices of the drugs factory review provided in art. 65d, al. 1, OAMal. It examines in a block drugs that belong to the same group therapeutic (IT) of the list of specialties.
IT groups are distributed in the following blocks, in accordance with art. 65d, al. 1, OAMal: a. block A: 1 gastroenterologica (04), 2. metabolism (07), 3. antidotes (15), 4. exchangers of cations (16), 5. radionuclides (17), 6. gastroenterologica (complementary medicines) (54), 7. metabolism (complementary medicines) (57);

b. block B: 1. nervous systems (01), 2. kidneys and solutions of substitution (05), 3. blood (06), 4. dermatologica (10), 5. odontostomatologica (13), 6. Diagnostica (14), 7. nervous systems (complementary medicines) (51), 8. kidneys and alternatives (complementary medicines) (55), 9. blood (complementary medicines) (56), 10. dermatologica (complementary medicines) (60);

c. block C: 1 heart and circulation, (02) 2. System respiratory (03), 3. diseases infectious (08), 4. gynaecologica (09), 5. ophtalmologica (11), 6. OTO-rhinolaryngologica (12), 7. heart and circulation (complementary medicines) (52), 8. respiratory system (complementary medicines) (53), 9. infectious diseases (complementary medicines) (58), 10. gynaecologica (complementary medicines) (59), 11. ophtalmologica (complementary medicines) (61), 12. OTO-rhinolaryngologica (complementary medicines) (62).

The review referred to in para. 1 does not apply to the following original preparations: a. original preparations whose price has been reviewed since the last review of the economic character due to an extension of the indications or of a modification or deletion of a limitation under art. 65F, al. sentence 2, 2, OAMal; The FOPH shall review of these original preparations at the earliest in the second year following the last review of the price; b. original preparations appearing on the list of the specialities for less than 13 months to January 1 of the year of the review.

Introduced by section I of O of the DFI on Apr. 29. 2015, in force since June 1, 2015 (RO 2015 1359). See disp. Trans. some mod. of the 29 Apr 2015 and 21 oct. 2015 at the end of the text.
Introduced by chapter I of the O of the DFI on 21 oct. 2015, in effect since Nov. 15. 2015 (2015 4189 RO).
New content according to chapter I of O of the DFI from 21 oct. 2015, in effect since Nov. 15. 2015 (2015 4189 RO).

Art. admission requirements 34ereexamen all three years: comparison with prices charged abroad the holder of the authorization provides the FOPH, no later than February 15 of the year of the review, the prices of manufactures in all countries in reference to January 1 of the year of the review as well as updated data with an indication of the information related to the drug that have changed since the previous review.
At the request of the FOPH, the holder of the authorisation submits the following documents: a. the prices of manufactures in all countries in reference to January 1 of the year of the review, certified by a person authorized to represent the holder abroad, a competent authority or competent association; b. in the first review, the number of the original preparation packages sold in Switzerland since admission to the list of specialties shown separately for each marketed form.

To calculate the price referred to in para. 1, the holder of the authorization, which distributes the original preparation communicates to the FOPH for all forms sold of the same active substance, what is the package that generated the biggest turnover in Switzerland in the last twelve months. The FOPH can require the numbers in question.
A price of manufactures in Switzerland less than the average factory price of the country of reference does not justify a price increase.

Introduced by section I of O of the DFI on Apr. 29. 2015, in force since June 1, 2015 (RO 2015 1359). See disp. Trans. of this mod at the end of the text.

Art. eligibility every three years 34freexamen: comparison with other drugs when a comparison is made with other original preparations (art. 65d, para. 3, OAMal), the price is the price of manufactures of these original preparations to September 1 of the year of the review.
The original preparations taken into account are those whose directions are the same or similar effects (art. 34, para. 1 let. a) and which appear on the list of specialties at the time of the review.
The comparison is usually made based on the smallest packaging and the smallest dosage.

Introduced by section I of O of the DFI on Apr. 29. 2015, in force since June 1, 2015 (RO 2015 1359). See disp. Trans. of this mod at the end of the text.

Art. eligibility every three years 34greexamen: review the effectiveness of generics as part of the review referred to in art. 34, al. 1, generics are deemed economic if their factory price is lower than the price of factory of the original preparations corresponding to 1 September of the year of the review, specifically: a. If it is lower by at least 10% and that the volume of the market of the original preparation of its co-marketing and its generic drug does not on average 4 million francs per year for the three years preceding the year of review; b. is it their is at least 20% less in all other cases.

When a comparison is made with other drugs for the original preparation, the calculated factory price is decisive for the assessment of the economic nature of generics.

Introduced by section I of O of the DFI on Apr. 29. 2015, in force since June 1, 2015 (RO 2015 1359). See disp. Trans. of this mod at the end of the text.
New content according to chapter I of O of the DFI from 21 oct. 2015, in effect since Nov. 15. 2015 (2015 4189 RO).

Art. 34hreexamen of eligibility every three years: volume and timing of the drop in the price of factory if the review of eligibility every three years results in a decline in prices, the calculated percentage of decline applies to prices of marketed forms of the same active substance factory.
The FOPH lowers the price of a drug with effect factory on September 1 of the year of the review.

Introduced by section I of O of the DFI on Apr. 29. 2015, in force since June 1, 2015 (RO 2015 1359). See disp. Trans. of this mod at the end of the text.

Art. 35 repealed by no I of O of the DFI from 29 Apr. 2015, with effect from 1 June 2015 (RO 2015 1359).

Art. 35 introduced by chapter I of O of the DFI on 27 nov. 2000 (RO 2000 3088). Repealed by no I of O of the DFI on Apr. 29. 2015, with effect from 1 June 2015 (RO 2015 1359).

Art. 35b introduced by section I of O the DFI on 2 July. 2002 (RO 2002 3013). Repealed by no I of O of the DFI on Apr. 29. 2015, with effect from 1 June 2015 (RO 2015 1359). See also the disp. Trans. mod. of June 30, 2010, at the end of the text.

Art. 35 c introduced by section I of O of the DFI on June 30, 2010 (RO 2010 3249). Repealed by no I of O of the DFI on Apr. 29. 2015, with effect from 1 June 2015 (RO 2015 1359). See also the disp. Trans. of this mod at the end of the text.

Art. 36 assessment of economic character in the first 15 years the drugs which are the subject of a request for price increase are subject to a review of the FOPH to check that the conditions for admission laid down in art. 32 to 35 are still met.
If this review reveals that the required price is too high, the FOPH rejects the request.
CFM can ask the FOPH to remove completely or in part the premium innovation if the conditions that in had determined the grant are no longer met.

New content according to chapter I of O of the DFI from 26 APR. 2006, in force since May 10, 2006 (RO 2006 1757).
New content according to chapter I of O of the DFI from 26 APR. 2006, in force since May 10, 2006 (RO 2006 1757).
New content according to chapter I of O of the DFI on May 8, 2013, in force since June 1, 2013 (RO 2013 1357).

Art. 37reexamen of the admission requirements at the expiration of the patent for the review of an original preparation provided in art. 65th OAMal, the holder of the authorization must communicate spontaneously to the FOPH, no later than six months before the date of protection of the patent, the prices in all the reference countries and the turnover of the three years prior to the expiration of the patent, in accordance with art. 65 c, al. 2 to 4, OAMal.

New content according to chapter I of O of the DFI from 29 Apr. 2015, in force since June 1, 2015 (RO 2015 1359).


Art. 37aExtension of indications or modification of limitation: documents required for the review of an original preparation due to a new indication within the meaning of art. 65F OAMal, the holder of the authorization shall provide the FOPH, the original preparation is coupled with a limitation or not: a. the authorization decision; (b) the certificate of approval; (c) the final version of the manual intended for the medical profession; (d) the documents referred to in art. 30, art. 1, let. b to f, and 2.

For the review of an original preparation due to the change or deletion of a restriction within the meaning of art. 65F OAMal, the holder of the authorization must provide the FOPH documents referred to in art. 30. The FOPH informs CFM of any extension of the indications and any request for modification of a limitation.

Introduced by chapter I of O of the DFI on 26 April. 2006 (RO 2006 1757). New content according to chapter I of O of the DFI from 29 Apr. 2015, in force since June 1, 2015 (RO 2015 1359).

Art. 37bRestriction of the indication for the review of an original preparation because of a restriction to the indication authorized within the meaning of art. 65g OAMal, the holder of the authorization shall provide the FOPH: a. the authorization decision; (b) the certificate of approval; (c) the final version of the manual for the medical profession; d. documents containing information and clinical data on the basis of which Swissmedic has decided to change the permission.

The FOPH can inform the CFM of the restriction of an indication.

Introduced by section I of O of the Apr. 26, DFI. 2006 (RO 2006 1757). New content according to chapter I of O of the DFI from 29 Apr. 2015, in force since June 1, 2015 (RO 2015 1359).

Art. 37 c introduced by section I of O the DFI 26 APR. 2006 (RO 2006 1757). Repealed by no I of O of the DFI of Sept. 24. 2007 (2007 4443 4633 RO).

Art. 37dEtendue and time of the reviews referred to the art reviews. 37 at 37 c include all sizes of packaging, dosages and dosage forms of the original preparation.


Introduced by section I of O of the Apr. 26, DFI. 2006, in force since May 10, 2006 (RO 2006 1757).
Repealed by no I of O of the DFI on Apr. 29. 2015, with effect from 1 June 2015 (RO 2015 1359).

Art. the surplus the FOPH 37eRemboursement check if a surplus of revenue within the meaning of art. 67A OAMal has been achieved: a. when the first review of the conditions of admission to the senses of the art. 34 to 34 and 34 h; b. to the outcome of an appeal procedure; (c) two years after an extension of the indications or a change in the limitation that followed a drop in the price of manufactures in accordance with art. 65F, al. 2, 1 sentence, OAMal.

All marketed forms of a drug are taken into account in the calculation.
The surplus in the cases referred to in para. 1, let. a and b, is calculated as follows a. established first the difference between factory during the admission price or the price of factory during the appeals process and the price of factory after the price drop; b. then, this difference is multiplied by the number of packages sold between the time of admission and that of lower prices or by the number of packages sold during the appeal proceedings.

The calculation of surplus income in the case referred to in para. 1, let. c, is based on the number of packages sold. If it is higher than the estimate of the holder of the authorization within the meaning of art. 65F, al. 2, 1 sentence, OAMal, the surplus is equivalent to 35% of the result of the following calculation: a. it first sets out, for each package, the difference between the number of effective packaging and the number of estimated packaging; (b) then this difference is multiplied for each package by the price of factory practiced before the drop in price referred to in art. 65F, al. 2, 1 sentence, OAMal; c. Finally, amounts achieved are added.

Determining exchange rates for the calculation of the surplus in the case provided for in para. 1, let. a, are those that were in effect on the date of admission of the preparation.
If the FOPH has doubts based on the accuracy of the indications given by the holder of the authorisation, he may require it to confirm these indications, for the medicinal product concerned, by the external auditors.
If the holder of the authorisation lowers on its own before 1 September of the year of the review of the price of its original preparation factory at the level of the factory price determined in art. 65d OAMal, it notifies the FOPH the price of factory of the country of reference at the time of voluntary reduction in the price. If this decline occurred in the first 18 months following the admission of the original preparation in the list of specialties, the holder of the authorization is not required to refund the surplus, in derogation from art. 67, art. 1, OAMal.
The FOPH fixed in its decision to refund the amount of the surplus and the deadline to pay it to the common institution.

Introduced by section I of O of the DFI on Apr. 29. 2015, in force since June 1, 2015 (RO 2015 1359).
New content according to chapter I of O of the DFI from 21 oct. 2015, in effect since Nov. 15. 2015 (2015 4189 RO).

Art. 38Part relating to the distribution of the premium relative to the price for drugs that are delivered only on prescription amounts to: a. 12% for a price of up to 879 fr. 99 factory; b. 7 percent for a price of between 880 francs factory and 2569 fr. 99; c. 0% for a price greater than or equal to 2570 francs factory.

The premium packaging for drugs that are delivered on prescription amounts to: a. 4 francs for a price of up to 4 fr. 99 factory; b. 8 francs for a price of including factory between 5 francs and 10 fr. 99; c. 12 francs for a price of including factory between 11 francs and 14 fr. 99; d. 16 francs for a price of including factory between 15 francs and 879 fr. 99; e. 60 francs for factory priced between 880 francs and 2569 fr. 99; f. 240 francs for a factory price greater than or equal to 2570 francs.

The premium relative to the price for drugs that are delivered without prescription amounts to 80% of the price of manufactures.
Relative to the distribution share is fixed for all providers of services in a uniform manner. The FOPH can also take into account specific situations of distribution.

Formerly art. 35 a. introduced by section I of O the DFI 27 nov. 2000 (RO 2000 3088). New content according to chapter I of the O of the DFI from 1 July. 2009, in force since Oct. 1. 2009 (2009 4251 RO).

Section 4Quote-part of Art. drugs 38a share amounts to 20% of costs exceeding the franchise for the medicines exceeds the maximum price more of 20% the average maximum prices of one-third the most advantageous of all drugs containing the same active substance and on the list of specialties.
The calculation of the average of the third cheapest is determined by the maximum price of the packaging that has the turnover most raised by dosage of a commercial form of all drugs containing the same active substance and entered on the list of specialties. Packages, which do not cause any turnover over a period of three consecutive months before the determination of the most advantageous middle third of these drugs are not taken into account.
The determination of the average of the third lowest is 1 September or the registration of the first generic on the list of specialties.
If, for an original preparation or a drug in co-marketing, the holder of the authorisation lowers at once, after the expiry of the patent, the factory price at the level of the price of the generic in the sense of art. 65 c, al. 2, OAMal, a share of 10% of the franchise costs applies to this medication during the first 24 months as of the fall in the price.
The al. 1 is not applicable when the doctor or the chiropractor requires expressly, for medical reasons, original preparation.
The chiropractor or the doctor informs the patient when at least a generic that is interchangeable with the original preparation is in the list of specialties.

New content according to section I of the O of the DFI on Feb 2. 2011, in effect since March 1, 2011 (RO 2011 657). See the disp. Trans. of this mod at the end of the text.
New content according to chapter I of O of the DFI from 21 oct. 2015, in effect since Nov. 15. 2015 (2015 4189 RO).

Title 2 Conditions for the right to provide benefits Chapter 1...

Art. 39 repealed by no I of the DFI O from 2 July. 2002, with effect from July 1. 2002 (RO 2002 3013).

Chapter 2 chiropractic schools art. 40 schools of chiropractic recognized within the meaning of art. 44, al. 1, let. a, OAMal are specified in art. 1 of the Ordinance of the DFI on 20 August 2007 on courses of study recognized chiropractic offered by some foreign universities.

New content according to art. 2 o of the DFI on 20 August 2007 on courses of study recognized chiropractic offered by high foreign academic schools, in effect since Sept. 1. 2007 (2007 4085 RO).
RS 811.115.4 Chapter 3...

Art. 41 repealed by no I of O of the DFI on 29 June 1999, with effect from Jan 1. 2000 (RO 1999 2517).

Chapter 4 laboratories art. 42 training and post-graduate training


Are recognized as academic training within the meaning of art. 54, al. 2 and 3, let. a, OAMal, complete university studies in dental medicine, veterinary medicine, chemistry, biochemistry, biology or microbiology.
Are recognized as superior to the senses of the art training. 54, al. 2, OAMal: a. the diploma of "technician medical with higher vocational training CRS' issued by a training institution recognized by the Swiss Red Cross; b. the diploma of" technician in biomedical analyses WITH higher vocational training CRS ' issued by an institution of training recognised by the Swiss Red Cross; c. the attestation of equivalence of Chief technician issued by the Red Cross Switzerland; d. the federal diploma of "expert in biomedical analysis and management of laboratory" or a recognized equivalent diploma.

Is deemed to be training postgraduée within the meaning of art. 54, al. 3, let. b, OAMal, recognized by the Swiss Association of Heads of medical laboratory (FAMH) post-graduate training in hematology, clinical chemistry, Clinical Immunology and medical microbiology. The federal Department of the Interior determines the equivalence of a post-graduate training which does not meet the regulations of the FAMH.


New content according to chapter I of O of the DFI on May 16, 2014, in force since July 1. 2014 (2014 1251 RO).
Repealed by no I of O of the DFI on April 4, 2007, with effect from April 1, 2007 (RO 2007 1367).

Art. Additional 43Exigences of medical genetics analyses listed in chapter genetics of the list of analyses can be performed in laboratories: a. which the leader can justify a recognized training in line with the conditions set out in art. 42, al. 1, and training postgraduée genetic medical (human genetics focuses on the health and disease) recognized by the FAMH or considered equivalent by the federal Department of the Interior, in accordance with the conditions set out in art. 42, al. 3; b. with for such analyses, authorisation of the FOPH for human genetic analysis.

Some analysis contained in chapter genetics of the list of analyses can also be performed in laboratories which the Chief justification for post-graduate training recognized by the FAMH or considered equivalent by the federal Department of the Interior, and including medical genetics. Post-graduate training requirements are defined in the list of analyses for each analysis (suffix).

New content according to section I of the O of the DFI on Nov. 17. 2003, in force since Jan. 1. 2004 (RO 2003 5283). See also the disp. end of this mod at the end of the text.
New content according to chapter I of the O of the DFI on April 4, 2007, in force since April 1, 2007 (RO 2007 1367).
See also the disp. end of the mod. April 4, 2007, at the end of the text.

Title 3 provisions final art. 44 repeal of the law in force are repealed: a. order 2 of the DFI on February 16, 1965, on Medicare, setting the contributions of insurers at the expense of diagnosis and treatment of tuberculosis; b. order 3 of the DFI on May 5, 1965 on Medicare on the exercise of the right to supply Federal for medical and pharmaceutical care disabled; c. order 4 of the DFI on 30 July 1965 on insurance concerning recognition and surveillance of the sq. admitted to receive insured minors; d. order 6 of the DFI on 10 December 1965 on Medicare about the institutes of chiropractic recognized; e. order 7 of the DFI of 13 December 1965 Medicare treatment scientifically recognized to be supported by the recognized sickness; f. the order 8 of the DFI of 20 December 1985 on Medicare treatment psychotherapeutic charged to the recognized sickness; g. order 9 of the DFI of 18 December 1990 on Medicare on some diagnostic measures or treatment borne by sickness funds recognised; h. the order 10 of the DFI on November 19, 1968 on Medicare about the admission of drugs on the list of specialties; i. order of the DFI on 28 December 1989 on drugs must be taken in charge by the recognized sickness; k. order of the DFI of 23 December 1988 on tests must be taken in charge by the recognized sickness.

[RO 1965 131, 1970 949, 1971 1719, 1986 1487 ch. II]
[RO 1965 429, 1968-1052, 1974 688, 1986 891]
[RO 1965 619, 1986 1487 ch. II]
[RO 1965 1211, 1986 1487 ch. II, 1988 973]
[RO 1965 1213, 1968 838, 1971 1258, 1986 1487 ch. II, 1988 2012, 1993 349, 1995-890]
[1986-87 RO]
[RO 1991 519, 1995 891]
[RO 1968 1543, 1986 1487]
[RO 1990 127, 1991-959, 1994 765]
[RO 1989 374, 1995 750 3688]

Art. 45 repealed by no I of O of the DFI from nov 27. 2000, with effect from Jan 1. 2001 (RO 2000 3088).

Art. 46 entry into force this order comes into force on January 1, 1996.



New content according to chapter I of O of the DFI on Feb 26. 1996, in force since June 1, 1996 (RO 1996 1232).
Repealed by no I of O of the DFI on 15 Jan. 1996, with effect from 1 May 1996 (RO 1996 909).
Repealed by no I of O of the DFI of Feb. 26. 1996, with effect from June 1, 1996 (RO 1996 1232).

Final provision of the amendment on 17 November 2003 final provisions of the amendment of July 3, 2006 final provisions of the amendment of April 4, 2007 transitional provisions of the amendment of September 19, 2007 transitional provisions of the amendment of June 30, 2010 transitional provisions of the amendment of 2 February 2011 transitional provisions of the amendment on March 21, 2012 transitional provision relating to the amendment of April 29, 2015 transitional provisions relating to the modification of the October 21, 2015 the first review of eligibility provided every three years according to the rules laid down in art. 34 is done in 2016 for block A, in 2017 for block B and in 2018 for the C block.
For drugs that have been admitted to the list of specialties before 1 June 2015, the repayment of the surplus is governed by the al. 3 the transitional provision relating to the amendment of April 29, 2015.

Annex 1 (art. 1) supported by the mandatory healthcare insurance of certain services provided by physicians preliminary remarks this annex is based on art. 1 of the Ordinance on the health insurance benefits. It does not contain an exhaustive list of the services provided by doctors, to load or not Medicare. It shows:-including effectiveness, adequacy, or the economic benefits have been reviewed by the Commission services and principles and which costs are supported, as appropriate under certain conditions, or are not supported; - benefits including effectiveness, adequacy or economic character are still being evaluated, but which costs are supported to some extent and under certain conditions; - benefits particularly expensive or difficult that not are supported by compulsory care insurance only when they are practiced by qualified suppliers of services.

Table of contents of annex 1 1 Chirurgie1.1 surgery generale1.2 transplantation1.3 Surgery Orthopedics, urology traumatologie1.4 and proctologie2 medicine interne2.1 medicine internal generale2.2 cardiovascular disease, medical intensive2.3 Neurology, including the therapy of pain and the physical medicine anesthesie2.4, rhumatologie2.5 Oncologie3. Gynecology, obstetrique4. Pediatrics, Psychiatry of the child5. Dermatologie6. Ophtalmologie7. ENT-laryngologie8. Psychiatrie9. Radiologie9.1 Radiodiagnostic9.2 other methods of imagerie9.3 Interventional Radiology and radiotherapie10. Medicine complementaire11. Rehabilitation measure necessarily dependants of Insurance Conditions valid from the surgery 1.1 1 Decision surgery General measures in the event of a Yes are included heart surgery: cardiac catheterization; angiocardiographie, product contrast understood; hypothermia; use of the heart-lung machine. use of a Cardioverter as a pacemaker, defibrillator or cardiac monitor; stored blood and fresh blood. laying of an artificial valve, prosthesis included; installation of a pacemaker, including device.

1.9.1967 stabilization system for operation of coronary bypass in beating heart Yes all patients needing bypass surgery.
In the following cases a special benefit can be expected from this method: - very calcified aorta - renal failure; - chronic obstructive respiratory syndrome; - advanced age (more than 70-75 years).

Contraindications: - blood vessels very calcified or diffuse and very small (1.5 mm or more); - instability intraoperative hemodynamics because of the manipulation of the heart or ischemia.

1.1.2002 Yes breast reconstruction to restore the integrity of the patient after total or partial breast removed medically indicated.

23.8.1984/ 1.3.1995/ 1.1.2015 Yes for intact Breast Reduction correct breast asymmetry and restore the integrity of the patient after total or partial breast removed medically indicated.

1.1.2015 autotransfusion 1.1.1991 surgical treatment of fatness Yes Yes


The patient has a body mass index (BMI) greater than 35.
Slimming treatment of two years remained without effect.
Laying of the indication, realization, quality assurance and control of monitoring, as provided in the document medical guidelines for the surgical treatment of obesity of the Swiss Study Group for Morbid Obesity and Metabolic Disorders (SMOB) on 25 September 2013.
Achievement in centres which, because of their organization and their staff, are able to meet the medical guidelines of the SMOB to September 25, 2013 for the surgical treatment of fatness. Centers recognized by the SMOB in accordance with the administrative guidelines for the surgical treatment of obesity of the 25.09.2013 shall meet these conditions.
If the intervention must be conducted in a centre that is not recognized by the SMOB, the medical officer must give its prior consent.

1.1.2000/ 1.1.2004/ 1.1.2005/ 1.1.2007/ 1.7.2009/ 1.1.2011/ 1.1.2014 fatness by intragastric balloon treatment no 25.8.1988 Ablation thermal corticotherapy of veins in saphenous If yes varicose veins by radiofrequency or laser only by doctors with certificate of training continues (AFC) in ablation thermal corticotherapy of saphenous veins when varicose veins.

1.7.2002/ 1.1.2004/ 1.1.2016 treatment of varicose veins by ablation mechanic-chemical type Clarivein® corticotherapy not 1.7.2013 1.2 isolated kidney transplant transplant surgery Yes include operation of the donor fees, including the handling of potential complications as well as the benefits referred to in art. 14, al. 1 and 2, of the Act of 8 October 2004 on transplantation and art. 12 of the order of 16 March 2007 on the transplant.
The liability of the insurer to the receiver in case of eventual death of the donor is excluded.

25.3.1971/ 23.3.1972/ 1.8.2008 isolated heart transplant Yes in case of heart disease serious and incurable such as ischemic heart disease, idiopathic cardio-myopathie, heart defects and the malignant arrhythmia.

31.8.1989 isolated the lung transplant from a donor not living Yes terminal stage of lung disease chronic.
In the following centers: Universitätsspital Zürich, University cantonal Hospital of Geneva in collaboration with the Hospital University Vaud, if the centres participate in the register of SwissTransplant.

1.1.2003 heart-lung transplant not 31.8.1989/1.4.1994 Transplantation isolated liver Yes Execution in a center that has the necessary infrastructure and adequate experience ("minimum frequency": on average ten transplants of liver per year).

31.8.1989/1.3.1995 liver transplant from a donor living Yes in the following centers: University of Geneva, if the centres participate in the register of Swisstransplant Universitätsspital Zurich, cantonal hospital.
Include the operating expenses of the donor, including the treatment of possible complications as well as the benefits referred to in art. 14, al. 1 and 2, of the law on transplantation and art. 12 of the order on the transplant.
The liability of the insurer to the receiver in case of eventual death of the donor is excluded.

1.7.2002/ 1.1.2003/ 1.1.2005/ 1.7.2005/ 1.7.2008/ 1.1.2012 simultaneous transplant of pancreas and kidney Yes in the following centers: University of Geneva, if the centre is involved in the registry of SwissTransplant Universitätsspital Zürich, cantonal hospital.

1.1.2003 transplant of pancreas after a transplantation of the kidney Yes in the following centers: Universitätsspital Zürich, Geneva University hospitals, if centres participate in the register of Swisstransplant.

1.7.2010 isolated transplant of pancreatic Yes in the following centers: Universitätsspital Zürich, Geneva University hospitals, if centres participate in the register of Swisstransplant.

31.8.1989/1.4.1994/ 1.7.2002/ 1.7.2010 simultaneous Transplantation of islets of Langerhans and kidney Yes in the following centers: Universitätsspital Zürich, Geneva University hospitals, if centres participate in the register of Swisstransplant.

1.7.2010 transplantation of islets of Langerhans after a transplantation of the kidney Yes in the following centers: Universitätsspital Zürich, Geneva University hospitals, if centres participate in the register of Swisstransplant.

1.7.2010 Allotransplantation isolated islets of Langerhans Yes in the following centers: Universitätsspital Zürich, Geneva University hospitals, if centres participate in the register of Swisstransplant.

1.7.2002/ 1.7.2010 Autotransplantation isolated islets of Langerhans Yes in the following centers: Universitätsspital Zürich, Geneva University hospitals, if centres participate in the register of Swisstransplant.

1.7.2002/ 1.7.2010 isolated intestine transplant hail Yes in the following centers: Universitätsspital Zürich, Geneva University hospitals, if centres participate in the register of Swisstransplant.

Hail 1.7.2002/ 1.7.2010 Transplantation of the intestine and of the liver and transplant he Yes in the following centers: Universitätsspital Zürich, Geneva University hospitals, if centres participate in the register of Swisstransplant.

1.7.2002/ culture (keratinocytes) Yes adults autologous epidermis graft 1.7.2010:-Burns to 70% or more of the total body surface; - deep burns to 50% or more of the total body surface.

Children:-Burns to 50% or more of the total body surface; - deep burns to 40% or more of the total body surface.

1.1.1997/ 1.1.2001 wound treatment hardly curable through a transplant of skin out of a culture Yes alien or autogenous skin Equivalents allowed according to the legal requirements.
After conservative treatment has failed.
Installation of the indication and selection method or product according to the directives of April 1, 2011 on the use of equivalents of skin wounds hardly curable, issued by the Swiss society of Dermatology and Venereology and the Swiss Association for the care of wounds.
In centres recognized by the Swiss society of Dermatology and Venereology and the Swiss Association for the care of wounds.
If the treatment must take place in a centre that is not recognized by the Swiss society of Dermatology and Venereology and the Swiss Association for the care of wounds, the medical officer must give its prior consent.

1.1.2001/ 1.7.2002/ 1.1.2003/ 1.4.2003/ 1.1.2004/ 1.1.2008/ 1.8.2008/ 1.1.2012 1.3 orthopedics, trauma treatment of the defects of posture Yes mandatory service only for clearly therapeutic treatments, i.e. If structure or malformations of the spine detectable on x-ray changes have become apparent. The prophylactic measures that are intended to prevent any imminent changes to the skeleton, such as special gymnastics to strengthen a weak back, are not paid by insurance.

16.1.1969 treatment of osteoarthritis by intraarticular a injection lubricant artificial No 25.3.1971 treatment of osteoarthritis by injecting intra-articular teflon or silicone as a "lubricant" No 12.5.1977 treatment of osteoarthritis by injection of a mixed solution containing no 1.1.1997 shock wave therapy oil iodoform out-of-body (lithotripsy) applied to musculoskeletal No 1.1.1997/ 1.1.2000/ 1.1.2002 shock wave therapy radial Non 1.1.2004 Protection of hips to prevent fractures of the neck of femur Non 1.1.1999/ 1.1.2000

Registry osteochondrale tiled to cover damage to the bone or cartilage not 1.1.2002 autologous chondrocytes No 1.1.2002/ 1.1.2004 Viscosupplementation for the treatment of osteoarthritis Non 1.7.2002/ 1.1.2003/ 1.1.2004/ Kyphoplasty 1.1.2007 to balloon for treatment of vertebral fractures Yes recent, painful Fractures, vertebral body which are unresponsive to analgesic treatment and which show a deformity that needs to be corrected.
Indications according to the guidelines of the Swiss society of spinal surgery 23.9.2004.
The operation must be performed by a qualified surgeon. Surgeons recognized by the Swiss society of spinal surgery, Swiss society of Orthopedics and the Swiss society of neurosurgery are deemed sufficiently qualified.
If intervention must be performed by a surgeon not recognized by the Swiss society of spinal surgery, Swiss society of Orthopedics and the Swiss society of neurosurgery, the medical officer must give its prior consent.

1.1.2004/ 1.1.2005/ 1.1.2008/ 1.1.2011/ 1.1.2013 pads gel in the case of a total knee prosthesis not 1.1.2006 to collagen meniscus Implant No 1.8.2008 Menisectomie laser 1.1.2006 1.4 urology and proctology Uroflowmetrie (measurement of urinary by recording of curves flow) Yes 3.12.1981/ 1.1.2012 lithotripsy kidney extra body by shockwaves (ESWL), fragmentation of kidney Yes Indications the ESWL is indicated when conservative treatment had no success and the spontaneous calculation elimination is regarded as unlikely, given its location, its form and its dimension, if a. terminology of the renal pelvis; b. terminology calicielles; c. middle of the ureter.


The increased risk caused by the special position of the patient during narcosis require appropriate anesthetic monitoring (special training of doctors and paramedical staff - aid in Anesthesiology - and adequate monitoring devices).

22.8.1985/ 1.8.2006 surgical treatment of disorders of the erection - penile prostheses Non 1.1.1993/ 1.4.1994 - surgery revascularization not 1.1.1993/ 1.4.1994 Implantation of an artificial sphincter Yes in case of severe incontinence 31.8.1989 laser treatment of the tumors proves or penis Yes 1.1.1993 - by caustic or coils Yes 1.3.1995 - varicocele embolization by balloons or by microcoils No 1.3.1995 Ablation Transurethral prostate using a laser directed by ultrasound not 1.1.1997 treatment by transuretrales (HETUMT) high-energy microwave no

1.1.2004 Electroneuromodulation roots sacred using a system implemented for the treatment of urinary incontinence and bladder emptying Yes socket disorders supported only if the insurer previously gave a special guarantee and with the express permission of the medical officer.
Cannot be done in a recognized institution, with a unit of urodynamic capable of performing a full dynamic assessment and a unit of neuromodulation for the evaluation of the function of peripheral nerves (test NCB).
After failure of conservative treatment (including rehabilitation).
After a positive test of stimulation (NCB).

1.7.2000/ 1.7.2002/ 1.1.2005/ 1.1.2008 Bladder disorders by microscope injection of botulinum toxin type A in the bladder wall Yes after failure of conservative treatment.
For the following indications:-Urinary Incontinence caused by neurogenic of the detrusor hyperactivity associated with neurological disease in adults. Cannot be done in an institution specializing in neuro-urology.-idiopathic overactive bladder in adults.

Cannot be done in an institution specialized in urology and uro-gynaecology.

1.1.2007/ 1.8.2008/ 1.7.2013/ 1.1.2014/ 1.1.2015/ 15.7.2015 Electroneuromodulation of the roots using a system implemented for the treatment of fecal incontinence Yes taking sacred supported only if the insurer has given prior special security and with the express permission of the medical officer.
Cannot be done in a recognized institution, with a unit of anorectal manometry and a unit of neuromodulation for the evaluation of the function of peripheral nerves (test NCB) capable of performing a full pressure assessment.
After failure of conservative treatment and / or surgical (including rehabilitation).
After a positive test of stimulation (NCB).

1.1.2003/ 1.1.2008 Stents urological Yes if surgery is contraindicated due to comorbidity or bodily injury, serious or for technical reasons.

1.8.2007 ultrasonic focused high-frequency (HIFU) for the treatment of prostate carcinoma No 1.7.2009 Transurethral photoselective vaporization of the prostate by laser (VPP) Yes symptoms of prostatic obstruction.

1.7.2011 2 2.1 medicine internal medicine internal General therapy by injection of ozone No 13.5.1976 treatment by hyperbaric O2 Yes - Actinic lesions chronic or late;

1.4.1994 - acute osteomyelitis of the jaw;
1.9.1988 - chronic osteomyelitis;

-syndrome of diabetic foot in the ≥2B according to the classification Wagner-Armstrong Stadium;
1.7.2011 - disease of decompression when the concept of accident is not satisfied. Treatment abroad when it is not possible to ensure that the transport to the next hyperbaric chamber inside Swiss territory is fast enough and clean enough the patient. In the centers cited in the 'Notice for emergency services' developed by the Divers Alert Network (DAN) and REGA.

1.1.2006/ 1.7.2011 Non - sudden deafness neurosensory idiopathic; 

1.1.2016 time to cells cool No 1.1.1976 Serocythotherapie No 3.12.1981 treatment of fatness Yes - if the weight is 20% or more the ideal maximum weight; - if a concurrent disease can be favourably influenced by the reduction of the weight.

7.3.1974 - by amphetamine derivatives not 1.1.1993 - by thyroid hormones No 7.3.1974 - by diuretics No 7.3.1974 - by the injection of choriogonadotrophine not 7.3.1974 hemodialysis ("artificial kidney") 1.9.1967 hemodialysis at home Yes Yes 27.11.1975 dialysis peritoneal 1.9.1967 enteral at home Yes Yes when a sufficient nutrition orally without using probe is impossible.

1.3.1995 Enteral nutrition at home without the use of probe Yes Indication asked according to the "guidelines of the Swiss society of clinical nutrition (SSNC) on Home care, artificial nutrition home" of January 2013 1.7.2002/ 1.7.2012/ 1.7.2013 Parenteral Nutrition at home Yes 1.3.1995 insulin through a pump to infusion continues Yes under the following conditions: - the patient is suffering from extremely labile diabetes; - his affection cannot be stabilized satisfactorily by the method of multiple injections; - treatment to the way of the pump is indicated and care by a qualified centre or, after consultation with the medical officer, by a specialized doctor installed in private practice who has the necessary experience.

27.8.1987/ 1.1.2000 parenteral infusion of antibiotics with a pump to continuous infusion, outpatient treatment Yes 1.1.1997 plasmapheresis Yes Indications: - hyperviscosity syndrome; - diseases of the immune system, when a plasmapheresis has proved to be effective — particularly in the event of: - mg-severe thrombocytopenic purpura - anemia hemolytic immune-leukemia - syndrome-Goodpasture syndrome GBS - acute poisoning - homozygous familial hypercholesterolemia.

25.8.1988 LDL - Apheresis homozygous Familial Hypercholesterolemia Yes implemented in a center that has the infrastructure and the necessary experience.

Heterozygous Familial Hypercholesterolemia Non 1.1.2005 25.8.1988/ 1.1.1993/ 1.3.1995/ 1.1.2005 no in case of refractory high cholesterol therapy 1.1.2007 hematopoietic stem cell transplant in centres recognized by the group "Swiss Blood Stem Cell Transplantation" (SBST).
Performance standards published by the Committee 'The Joint Accreditation Committee - ISCT & EBMT (JACIE)' and ' Foundation for the Accreditation of Cellular Therapy (Fact) ":" FACT - JACIE International Standards for Cellular Therapy Product Collection, Processing and Administration ", 5 edition, from March 2012.
The donor operation costs are also borne by the insurer of the recipient, including the treatment of possible complications as well as the benefits referred to in art. 14, al. 1 and 2, of the Act of 8 October 2004 on transplantation and art. 12 of the order of 16 March 2007 on the transplant.
The liability of the insurer to the receiver in the event of death of the donor is excluded.

1.8.2008/ 1.1.2011/ 1.7.2013 - autologous Yes - lymphomas-acute lymphatic leukemia - acute myeloid leukemia - myeloma multiple-neuroblastoma-medulloblastoma - germ tumor.

1.1.1997/ 1.1.2013 Yes in clinical studies: - syndrome-myelodisplastique chronic myelogenous leukemia - Sarcoma to Ewing sarcoma of fabrics soft-Rhabdomyosarcoma-Wilms Tumor.

1.1.2002/ 1.1.2008/ 1.1.2013 to the 31.12.2017 Yes as part of prospective multicentre clinical studies:-in the case of autoimmune disease.
Supported only if the insurer has given prior special security and with the express permission of the medical officer.
Failure of conventional therapy or disease progression.

1.1.2002/ 1.1.2008/ 1.1.2013 to the 31.12.2017 Non - recurrence of acute myeloid leukemia - recurrence of acute lymphatic leukemia - breast cancer, - carcinoma bronchial to small cells-congenital diseases - cancer of the ovary-solid tumor uncommon to the child 1.1.1997/ 1.1.2008/ 1.1.2013 - allogeneic Yes - myeloid leukemia acute - acute lymphatic leukemia - myeloid leukemia-chronic syndrome myelodisplasique-aplastic anemia - immune deficiency and congenital enzymopathie - Thalassemia and sickle cell anemia (donor genotypically HLA-identical)-myeloma-multiple tumor of the lymphatic system (Lymphoma Hodgkin (, non Hodgkin Lymphoma, chronic lymphatic leukemia) 1.1.1997/ 1.1.2013 Yes in clinical studies:-Carcinoma of the kidney.

1.1.2002/ 1.1.2008/ 1.1.2013 to the 31.12.2017 Yes as part of prospective multicentre clinical studies:-in the case of autoimmune disease.
Supported only if the insurer has given prior special security and with the express permission of the medical officer.
Failure of conventional therapy or disease progression.

1.1.2002/ 1.1.2008/ 1.1.2013 to the 31.12.2017 Non - tumors-solids 1.1.1997/ 1.1.2008 Non - breast cancer melanoma.

Intrahepatic biliary lithotripsy of gallstones Yes calculation 1.1.2013 1.1.2008/ 1.1.2002/; extrahepatic biliary calculation in the region of the pancreas and the bile.

Intraresiculaires calculations when the patient is inoperable (including laparoscopic cholecystectomy).

1.4.1994 polysomnography polygraphy Yes in case of strong suspicion of: - sleep apnea syndrome - movement legs during sleep-narcolepsy, periodic when the clinical diagnosis is uncertain-parasomnia severe (for ex. night epileptic dystonia or violent behaviors during sleep), when the diagnosis is uncertain and that a therapy is required.

Prescription and execution by centres qualified in accordance with the directives of 6 September 2001 of the Swiss society of sleep research, sleep and chronobiology medicine.

1.3.1995/ 1.1.1997/ 1.1.2002 Non routine examination of temporary insomnia and chronic insomnia, fibromyalgia and chronic fatigue syndrome.

1.1.1997 no strong suspicion of: - sleep and disorders of sleep, when the initial diagnosis is uncertain and only when the behavioral or drug treatment is unsuccessful; - persistent disturbances of the circadian rhythm, when the diagnosis is uncertain.

1.1.1997/ 1.1.2002/ 1.4.2003 no siblings of infants who died of sudden death syndrome.

1.7.2011 polygraphy Yes strong suspicion of sleep apnea syndrome.
Only run by a specialized doctor (respirology or Otolaryngology) that could justify training and hands-on experience in respiratory polygraphy 'directed by 6 September 2001 of the Swiss society of sleep research, sleep and chronobiology medicine' or 'guidelines of 26 March 2015 of the Swiss society of Otorhinolaryngology and cervicofacial surgery. "

1.7.2002/ 1.1.2006/ 1.1.2012/ 15.7.2015 Dosage of melatonin senique No 1.1.1997 multiple latencies to fall asleep (Multiple sleep latency test) Test Yes Indication and implementation by qualified centres according to the "guidelines for the certification of 'sleep medicine centres' for execution of Polysomnographic recordings ' 1999 Swiss society of sleep research, sleep and chronobiology medicine.

1.1.2000 hold of Awakening (Maintenance of wakefullness test) test Yes Indication and implementation by recognized centres according to the "guidelines for the certification of 'sleep medicine centres' for execution of Polysomnographic recordings ' 1999 Swiss society of sleep research, sleep and chronobiology medicine.

1.1.2000 actigraphy Yes Indication and implementation by centres qualified according to the "guidelines for the certification of 'sleep medicine centres' execution of Polysomnographic recordings" 1999 Swiss society of sleep research, sleep and chronobiology medicine.

1.1.2000 breath test (13 c) urea for derivative of Helicobacter pylori Yes 16.9.1998/ 1.1.2001 immunotherapy with dendritic cells for the treatment of Melanoma not 1.7.2002 photodynamic treatment the methylester of acid aminolevulinique Yes Keratosis, Bowen disease, basocelular carcinoma and thin squamous carcinoma Actinic.

1.7.2002 photodynamic treatment with acid 5-aminolevulinique Yes Patients presenting a benign Actinic Keratosis 1.1.2014 Calorimetry and/or measurement of body density in the treatment of adiposity 1.1.2004 Capsule endoscopy Yes for examination of the small intestine of the angle of Treitz at the valve ileocaecale - bleeding of origin unknown-chronic inflammation of the small intestine.

If the gastroscopy and colonoscopy have proved to be negative.
Supported only if the insurer has given prior special security and with the express permission of the medical officer.

1.1.2004/ 1.1.2006 Photophorese extracorporeal Yes Reticulomatose skin (Sézary syndrome).

1.1.1997 disease of the graft against the host in case of failure of conventional therapy (e.g. corticosteroids).

1.1.2009/ no in case of lung transplant 1.1.2009 1.1.2012 2.2 cardiovascular disease, intensive medicine Insufflation of oxygen not 27.6.1968 Massage sequential Peristaltic Yes 27.3.1969/ 1.1.1996 recording of ECG by telemetry Yes as indications, come before all into account pace and disorders of transmission, disorders of the circulation of the blood in the heart muscle (coronary heart disease).
The device can also be used to control the effectiveness of the treatment.

13.5.1976 implantable system for the registration of a subcutaneous ECG Yes according to the "recommendations on good practice in the diagnosis and treatment of arrhythmias by cardiac stimulation, internal defibrillation and percutaneous catheter ablation" of "Cardiac Stimulation and Electrophysiology" Working Group of the Swiss society of Cardiology on May 26, 2000.

1.1.2001 telephone surveillance of cardiac pacemakers No 12.5.1977 implants cardiac rythmologiques Yes 1.7.2010 telemedicine 1.7.2012/ 1.1.2015 Implantation of a defibrillator Yes 31.8.1989 use to bladder pump intra-aortalique in interventional cardiology 1.1.1997 revascularization by laser transmyocardique Yes No 1.1.2000 therapy of cardiac resynchronization on the basis of a pacemaker in triple room, location and change of aggregate Yes in case of severe heart failure chronic refractory with intraventricular asynchronism.
Under the following conditions: - chronic severe failure (NYHA III or IV) with a left ventricular ejection fraction ≤ 35% despite appropriate medical treatment; - bundle branch block left with lengthening of the QRS ≥ 130 milliseconds.

Investigation and implementation only in a center of Cardiology called, with an interdisciplinary team with the necessary skills in cardiac electrophysiology and the necessary infrastructure (echocardiography, console programming, cardiac cath lab).

1.1.2004 brachytherapy endocoronarienne 1.1.2003/ No 1.1.2003 Implantation of stent coronary drug delivery Yes 1.1.2005 coronary with balloon catheter angioplasty covered Paclitaxel Yes indications: - Restenosis intrastent - stenosis of small coronary arteries 1.7.2012 Intervention percutaneously aimed at treating a severe mitral insufficiency Yes for inoperable patients with severe mitral failure (mortality predicted 10 to 15% within 12 months) and whose heart valves have a morphology for this intervention.
Participation in the 'Swiss Mitra Registry' 1.1.2013 implementation trans-catheter of aortic valve (TAVI) Yes in course evaluation in case of severe aortic stenosis in inoperable patients and high-risk procedure to the following (cumulative) 1. Conditions of the TAVI procedure follow the European directives: "Guidelines on the management of válvular heart disease (2012 version)" 2. The TAVI procedure can be performed in institutions practicing heart surgery on place3. The admissibility decision of all patients for TAVI procedure should be taken within the team Heart, including at least an interventional cardiologist trained for interventions TAVI, a non Interventional cardiologist, a heart surgeon and an anesthesiste4. All centers practicing the TAVI procedure must provide their data to the SWISS TAVI Registry 1.7.2013 until the 30.6.2018 2.3 Neurology, including the therapy of pain and anesthesia Massages in case of paralysis resulting from disorders of the central nervous system Yes 23.3.1972 Visual evoked potential in the context of neurological examinations Yes 15.11.1979 Electrostimulation of the spinal cord by a neuro-stimulation system Yes treatment of severe chronic pain , above all of the pains of the désafférentation type (phantom pain), pain by adhesion of the roots after herniated disc and loss of sensitivity in the dermatomes correspondents, causalgies and especially the pain caused by fibrosis of the plexus after irradiation (breast cancer), when there is a strict indication and a test was performed using a percutaneous electrode.
Replacing the pulse generator is a mandatory service.

21.4.1983/ 1.3.1995 Electrostimulation of the deep brain structures by implementing a system of neurostimulation Yes treatment of chronic pain severe: pain of désafférentation of Central origin (e.g., intraspinal, or brain injury intradurale nerve laceration), when there is a strict indication and a test was performed using a percutaneous electrode. Replacing the pulse generator is a mandatory service.
Severe dystonia and inadequate control of symptoms by drug treatment.
Examinations and operations in specialized centres which have necessary infrastructure (Stereotactic neurosurgery, Neurology specializing in engines, Neuroradiology disorders).

1.7.2011 1.3.1995/ Electroneuro-modulation of the pelvic nerves using a system implemented by laparoscopy (procedure LION: Laparoscopic Implantation of Neuroprothesis) not 1.7.2013/ 1.7.2014


Stereotactic operation to treat Parkinson's disease chronic and refractory to non-surgical treatments (removal by radiofrequency and chronic stimulations of the pallidum, the thalamus and subthalamic nucleus) Yes diagnosis established of idiopathic Parkinson's disease.
Progression of symptoms on a minimum of two years.
Inadequate control of symptoms by the dopaminergic treatment (off phenomenon, fluctuations on / off, dyskinesias we).
Examinations and operations in specialized centres which have the necessary infrastructure (functional neurosurgery, Neurology, Neuroradiology).

1.7.2000 operation (removal by radiofrequency and chronic of the thalamus stimulation) Stereotactic to address the earthquake no Parkinson, chronic and refractory to non-surgical treatments Yes. diagnosis of an earthquake not Parkinson, progression of the symptoms on a minimum of two years, controls enough of the symptoms by drug treatment.
Examinations and operations in specialized centres which have the necessary infrastructure (neurological electrophysiology, functional neurosurgery, Neurology, Neuroradiology).

1.7.2002 treatment by focused ultrasound of the pallidum, the thalamus and subthalamic nucleus Yes evaluation courses.
For treatment:-an earthquake if diagnosis of idiopathic Parkinson's disease, progression of the symptoms on a minimum of two years, inadequate control of symptoms by the dopaminergic treatment (off phenomenon, fluctuations on / off, dyskinesias we);
-of an earthquake no parkinsonian (diagnosis), progression of the symptoms on a minimum of two years, control insufficient symptoms by drug treatment;
-severe neuropathic pain chronic, refractory to treatment.
Management of a registry of evaluation 15.7.2015 until the 30.6.2020 Electro-neurostimulation Transcutaneous (TENS) Yes if the patient himself uses the TENS Stimulator, the insurer shall refund the unit rental costs when the following conditions are met:-the doctor or, on behalf of it, the physiotherapist must have tested the effectiveness of TENS on patient and initiating the latter to the use of the Stimulator; - the medical officer must have confirmed that the treatment by the patient himself is indicated; - indication in the cases following:-pain due to a Neuroma; e.g. pain localized can be triggered by pressure in members amputees (stumps); - pain that can be triggered or reinforced by stimulation (pressure, extension or electrical stimulation) of a hotspot; e.g. type pain sciatica or syndromes of the shoulder and arm; - pain caused by compression of the nerves; e.g. omnibuses persistent pain after operation for a herniated disc or carpal.

23.8.1984 peripheral nerve stimulation of the occipital nerve Yes in case of refractory chronic migraine therapy within the meaning of the diagnostic criteria of the International Headache Society (International classification of headache disorders, 2nd edition, Cephalalgia 2004 (suppl 1) IHS ICHD-II code 1.5.1)

1.7.2014 Baclofen therapy using an implantable drug dispenser Yes if spasticity therapy-resistant.

1.1.1996 somatic chronic pain intrathecal treatment using an implantable drug dispenser Yes 1.1.1991 motor evoked potential in specialized neurological examinations Yes diagnosis of a neurological disease. The reviewer is awarded the certificate of capacity or the certificate of training in EEG or electroneuromyographie of the Swiss society of clinical neurophysiology.

1.1.1999 curative resection a home seizure Yes - evidence of the existence of an epileptic. lens - strong disability of the patient because of suffering due to disease comitiale. - Resistance to the pharmacotherapy. - investigation and enforcement in a Center for epileptics who has the adequate diagnostic facilities (electrophysiology, MRI, etc.), a service of neuro-psychology, surgical and therapeutic know-how and possibilities of follow-up treatment.

1.1.1996/ 1.8.2006 palliative epilepsy surgery by: commissurotomy-multiple sub-apiale operation (according to Morell-Whistler) - stimulation of the vagus nerve Yes taking care only if the insurer has given prior special security and with the express permission of the medical officer.
When the investigations show that curative focal Epilepsy Surgery is not indicated and a palliative method allows better control of seizures and an improvement in the quality of life.
Investigations and enforcement in a centre for epilepsy that has diagnostic equipment (electrophysiology, MRI, etc.), a service of neuro-psychology, surgical and therapeutic know-how and possibilities of follow-up treatment.

1.1.1996/ 1.7.2002/ 1.1.2005/ 1.8.2006/ 1.1.2009 Operation laser (laser decompression) of the herniated disc no 1.1.1997 treatment electrothermal intradiscal No 1.1.2004 Cryoneurolyse no for the treatment of pain of lumbar intervertebrales joints 1.1.1997 Denervation by radio frequency of joint LBD not 1.1.2004/ 1.1.2005 Spondylodese by intervertebral cage or bone graft Yes taking care only if the insurer has given prior special security and with the permission of the medical officer.
-Instability of the spine with herniated disc, recurrence of disc herniation or stenosis in patients with vertebral or radicular syndrome disabling, resistant to conservative treatment, caused by a pathology of degenerative spine with instability, clinically and radiologically verified.-after failure of a spondylodese later with pediculaires screw system.

1.1.1999/ 1.1.2002/ 1.7.2002/ 1.1.2004 disc prosthesis Yes in course assessment symptomatic cervical and lumbar intervertebral discs of the spine degeneration.
Failure of conservative therapy for 3 months (cervical spine) or 6 months (lumbar spine) - with the exception of patients with symptomatic degeneration of intervertebral discs in the cervical and lumbar spine, and suffering also, in stationary therapeutic conditions, uncontrollable pain, or at which progressive neurologic losses appear despite conservative therapy.
-2 segments maximum-minimum degeneration of adjacent segments degeneration - Absence of primary osteoarthritis of joints spine (lumbar spine) - Absence of primary segmental kyphosis (cervical spine) - taking into account all General contraindications.

The operation must be performed by a qualified surgeon. Surgeons recognized by the Swiss society of spinal surgery, Swiss society of Orthopedics and the Swiss society of neurosurgery are deemed sufficiently qualified.
If intervention must be performed by a surgeon not recognized by the Swiss society of spinal surgery, Swiss society of Orthopedics and the Swiss society of neurosurgery, the medical officer must give its prior consent.
Service providers engaged in the Institute for evaluative research in orthopaedic surgery of the University of Bern the data necessary for a national assessment.

1.1.2004/ 1.1.2005/ 1.1.2008/ 1.1.2009/ 1.7.2009/ 1.1.2011/ 1.1.2012 until the 31.12.2016 stabilization interspinous and dynamic of the spine (e.g. type DIAM) Yes under evaluation the operation must be performed by a qualified surgeon. Surgeons recognized by the Swiss society of spinal surgery, Swiss society of Orthopedics and the Swiss society of neurosurgery are deemed sufficiently qualified.
If the intervention must be performed by a surgeon not recognized by the Swiss society of spinal surgery, Swiss society of Orthopedics and the Swiss society of neurosurgery, the medical officer must give its prior consent.
Service providers engaged in the Institute for evaluative research in orthopaedic surgery of the University of Bern the data necessary for a national assessment.

1.1.2007/ 1.1.2008/ 1.1.2009/ 1.7.2009/ 1.1.2011/ 1.1.2012/ 1.1.2014 until 31.12.2016 stabilization surgery and dynamic of the spine (e.g. type DIAM) Yes under evaluation the operation must be performed by a qualified surgeon. Surgeons recognized by the Swiss society of spinal surgery, Swiss society of Orthopedics and the Swiss society of neurosurgery are deemed sufficiently qualified.
If intervention must be performed by a surgeon not recognized by the Swiss society of spinal surgery, Swiss society of Orthopedics and the Swiss society of neurosurgery, the medical officer must give its prior consent.
Service providers engaged in the Institute for evaluative research in orthopaedic surgery of the University of Bern the data necessary for a national assessment.

1.1.2007/ 1.1.2008/ 1.1.2009/ 1.7.2009/ 1.1.2011/ 1.1.2012 until 31.12.2013 dynamic stabilization of the lumbar spine (e.g. type DYNESYS) Yes


Evaluating the operation must be performed by a qualified surgeon. Surgeons recognized by the Swiss society of spinal surgery, Swiss society of Orthopedics and the Swiss society of neurosurgery are deemed sufficiently qualified.
If the intervention must be performed by a surgeon not recognized by the Swiss society of spinal surgery, Swiss society of Orthopedics and the Swiss society of neurosurgery, the medical officer must give its prior consent.
Service providers engaged in the Institute for evaluative research in orthopaedic surgery of the University of Bern the data necessary for a national assessment.

1.1.2007/ 1.1.2008/ 1.1.2009/ 1.7.2009/ 1.1.2011/ 1.1.2012/ 1.1.2014 until 31.12.2016 general anesthesia to perform a diagnostic or therapeutic intervention (including dental surgery) Yes if the diagnostic intervention or therapy must be performed under anesthesia due to a physical or mental disability serious.

1.7.2010 anaesthetic by infiltration, local and regional (segmental and local neural therapy) Yes 1.7.2011/ 1.7.2012 2.4 physical medicine, rheumatology treatment of osteoarthritis by intraarticular a injection lubricant artificial No 25.3.1971 treatment of osteoarthritis by injection intra-articular teflon or silicone as a "lubricant" No 12.5.1977 Synoviorthesis Yes 12.5.1977 cold laser therapy Non 1.1.2001 general anesthesia to perform a diagnostic or therapeutic intervention (including dental surgery) Yes if the diagnostic intervention or therapy must be performed under anesthesia to reason of a physical or mental disability is severe.

1.7.2010 2.5 Oncology cancer treatment by infusion pump (chemotherapy) Yes 27.8.1987 laser for palliative surgery treatment at least Yes 1.1.1993 infusion isolated from members in hyperthermia and through the factor of tumor necrosis (TNF) Yes malignant melanoma reaching only a member.
Soft tissue sarcoma reaching only a member.
In a specialized centre with experience in interdisciplinary treatment of melanomas and sarcomas extended members by this method. The treatment is carried out by a team of doctors specialized in oncological surgery, vascular surgery, orthopedics, anesthesia and intensive medicine.
The treatment should be performed in the operating room under general anesthesia and continuous monitoring by Swan-Ganz probe.

1.1.1997/ 1.1.2001 Non melanoma or sarcoma: - invading the root of the Member; - accompanied by visceral metastases.

Specific immunotherapy 1.1.2001 active 1.8.2007 Yes Low-dose-rate brachytherapy with iodine 125 or palladium 103 beans for stage II no colon cancer adjuvant therapy.
In the case of Carcinoma of the prostate with low or medium risk and - life expectancy > 5 years - volume prostate < 60 ccm - no severe bladder obstruction.

Center described as offering a close interdisciplinary collaboration between radio-oncologists, urologists and medical physicists.

1.7.2002/ 1.1.2005/ 1.1.2009/ 1.7.2011 Multigene Test in case of cancer of the breast (Breast Cancer Assay) Yes under evaluation Indication: breast cancer, primary, invasive with the following characteristics: - positive to the estrogen receptor (ER +); - negative to the 2 of the human epidermal growth factor (HER2) receptor; - with up to three lymph nodes loco-regional achieved; - the conventional results do not allow to clearly decide to adjuvant chemotherapy.

Requirements for the test: performed by a doctor who specializes in pathology with as the molecular pathology subspecialty. If the test takes place in a foreign laboratory, it must meet the standard ISO 15189 17025 or the IVDD 98/79/EC directive.

1.1.2011/ 1.1.2015 until the 31.12.2017 3 gynaecology, obstetrics ultrasound Yes art. 13, let. b, ASDS is reserved for controls by ultrasound during pregnancy.

23.3.1972/ 1.1.1997 Insemination artificial Intrauterine Insemination Yes.
A maximum of three cycles of treatment per pregnancy.

1.1.2001 fertilization in vitro to determine a possible sterility not 1.4.1994 fertilization in vitro and embryo (CPMA) transfer no 28.8.1986/1.4.1994 sterilization:-a patient practiced during the medical treatment of a patient of childbearing, age sterilization must be supported by Medicare in cases where pregnancy would put the life of the insured in danger or would likely affect her health in a sustainable way because of a likely permanent medical condition or a physical abnormality and if other methods of contraception are not possible for medical reasons (in the broad sense).

11.12.1980 - Yes spouse when a refundable sterilization turns out to be impossible for the woman or when it is not desired by the spouses, the insurer of the wife must support the sterilization of the husband.

1.1.1993 treatment laser of cancer of the cervix in situ Yes 1.1.1993 non surgical removal of endometrial Yes for the treatment of functional menorrhagia resistant to therapy in women before the menopause.

1.1.1998 smear of PAP for the early detection of cancers of the cervix (art. 12, let. b, ASDS) Yes 1.1.1996/ 1.8.2008 cytology in thin layers for the early detection of cancers of the cervix according to the ThinPrep or Autocyte Prep/SurePath methods (art. 12, let. b, ASDS) Yes 1.4.2003/ 1.7.2005/ 1.8.2008 Detection of human papillomavirus (HPV) for screening for cancer of the cervix (art 12. Let's. b, ASDS) No 1.7.2002/ 1.8.2008/ invasive breast Interventions under radiological or Ultrasonographic guidance Yes according to consensus statements of the Swiss society of senology (SSS) and the Working Group "Bildgesteuerte minimal invasive Mammaeingriffe." Breast health - Zeitschrift fur Mammadiagnostik und - therapy 2009; 6: 181-184.

1.7.2002/ 1.1.2007/ 1.1.2008/ 1.7.2009 establishment of a suburethral Strip for the treatment of the urinary stress incontinence in women Yes - according to the recommendations of the Association for the urogynecology and pathology of the pelvic floor (AUG), update the 27.7.2004 expert opinion "implementation of strips for the treatment of female urinary incontinence of effort" - the Reemex® implant is not supported.

1.1.2004/ 1.1.2005 4 Pediatrics, Psychiatry of children programs of ambulatory and multidisciplinary group treatments for children and adolescents with overweight or obesity Yes 1. Indication: a. in the case of obesity (BMI > 97 percentile); (b) in the case of overweight (BMI between the 90 and the 97 percentile) and presence of at least one of the diseases below if overweight to worse prognosis or if they are due to overweight: high blood pressure, diabetes mellitus type 2, disorders of carbohydrate tolerance, endocrine disorders, polycystic ovarian syndrome , orthopedic diseases, respiratory diseases, nonalcoholic steatohepatitis, glomerulopathie, eating disorders subject to psychiatric treatment.

Definition of obesity, overweight and diseases according to the recommendations of the Swiss society of Pediatrics (SSP) published in the journal Pediatrica n 6/2006 of 19 December 2006 and n 1/2011 March 4, 2011 2. Programs: programs in groups led by a physician with multidisciplinary therapeutic approach according to the requirements of the Swiss association of child and adolescent obesity published in the journal Pediatrica n 2/2007 April 13, 2007. Programs in a doctor-led groups that are recognized by the commission formed of representatives of the SSP and the Swiss association of childhood obesity and adolescents, are considered to meet these conditions. If the therapy is part of a program that is not recognized by this commission, the doctor must give its prior consent.

3. a fixed remuneration must be agreed.

1.1.2008/ 1.7.2009/ 1.1.2014/ 1.7.2014 no program reduced for children 4 to 8 years.

1.1.2014 multiprofessional individual therapy structured ambulatory care for children and adolescents Overweight / obesity in 4 steps Yes 1. Indication: a. in the case of obesity (BMI > 97 percentile); (b) in the case of overweight (BMI between the 90 and the 97 percentile) and presence of at least one of the diseases below if overweight to worse prognosis or if they are due to overweight: high blood pressure, diabetes mellitus type 2, disorders of carbohydrate tolerance, endocrine disorders, polycystic ovarian syndrome Orthopedic diseases, steatohepatitis not alcoholic, respiratory diseases, eating disorders glomerulopathie subject to psychiatric treatment.

Definition of obesity, overweight and diseases according to the recommendations of the Swiss society of Pediatrics (SSP) published in the journal Pediatrica n 6/2006 of 19 December 2006 and n 1/2011 March 4, 2011.
2 therapy: a. step 1: multidisciplinary monitoring by a doctor 6 months with maximum 6 dietary consultation sessions and 2 sessions of physiotherapy diagnosis, (b) steps 2 and 3: multidisciplinary programs run by a doctor if step 1 lasts more than 6 months or in the presence of a significant comorbidity, c. step 4: follow-up treatment by a doctor.


3 programs for steps 2 and 3:programmes in groups led by a physician with multidisciplinary therapeutic approach according to the requirements of the Swiss association of child and adolescent obesity published in the journal Pediatrica n 2/2007 April 13, 2007. Programs in a doctor-led groups that are recognized by the commission formed of representatives of the SSP and the Swiss association of childhood obesity and adolescents are deemed to meet these conditions. If the therapy is part of a program that is not recognized by this commission, the doctor must give its prior consent.

1.1.2014 therapy by the game and painting for children Yes practice by the physician or under his direct supervision.

7.3.1974 treatment of enuresis by warning device Yes from the age of 5 years 1.1.1993 Electrostimulation of bladder Yes organic problems of urination.

16.2.1978 group for obese children gymnastics No 18.1.1979 Monitoring of respiration; monitoring of respiration and heart rate Yes in infants at risk, on prescription from a doctor practicing in a regional centre of diagnosis of the sudden death of the infant (SIDS).

25.8.1988/ Ultrasound 1.1.1996 according to method of Graf of the hip of newborns and infants Yes review performed by a physician trained in this method.

1.7.2004/ 1.8.2008 stationary therapy away from home during adiposity severe not 1.1.2005 5 Dermatology treatment of skin diseases by the black light (PUVA therapy) Yes 15.11.1979 selective phototherapy with ultraviolet Yes under the responsibility and control of a physician.

11.12.1980 embolization of hemangiomas of the face (Interventional Radiology) Yes should not be charged more expensive than surgical treatment (excision).

27.8.1987 stimulation of cells by pulsed acoustic waves (PACE) for the treatment of acute or chronic skin healing problems not 1.7.2009 to laser treatment of: - telangiectasique nevi Yes 1.1.1993 - Condyloma acuminate Yes 1.1.1993 - acne scars No 1.7.2002 - keloid No 1.1.2004 climate therapy at the edge of the sea dead no 1.1.1997/ 1.1.2001 Balneo-therapy outpatient Non 1.7.2002 matrix extracellular organic of animal origin to three-dimensional structure Yes for the treatment of chronic wounds.
Installation of the indication and selection method or product according to the directive "Guidelines zum Einsatz von azellularen biological performance perspective bei schwer heilenden Wunden" from July 1, 2011, issued by the Swiss society of Dermatology and Venereology and the Swiss Association for the care of wounds.
In centres recognized by the Swiss society of Dermatology and Venereology and the Swiss Association for the care of wounds.
If the treatment must take place in a centre that is not recognized by the Swiss society of Dermatology and Venereology and the Swiss Association for the care of wounds, the medical officer must give its prior consent.

1.7.2011 treatment of wound by maggot Yes for the treatment of chronic wounds.

1.7.2011 treatment of lipoatrophy of the face by filling material Yes if facial lipoatrophy resulting from a medication or illness.
Supported only if the insurer has given prior special security and with the express permission of the medical officer.

1.7.2013 6 Ophthalmology orthoptic treatment by the doctor himself or under his direct supervision.

27.3.1969 Visual evoked potentials in ophthalmological examinations Yes 15.11.1979 biometrics by ocular ultrasound before Yes 8.12.1983 treatment laser cataract surgery of: - diabetic retinopathy Yes 1.1.1993 - retinal lesions (including retinal ischemia) Yes 1.1.1993 - capsulotomy Yes 1.1.1993 - trabeculotomie Yes 1.1.1993 Correction of Anisometropia by refractive surgery Yes delivery required only if there is a greater than 3 diopters Anisometropia not correctable by glasses and a sustainable intolerance to contact lenses; for the correction of an eye for get values correctable by glasses.
Supported only if the insurer has given prior special security and with the express permission of the medical officer.

1.1.1995/ 1.1.1997/ 1.1.2005 refractive Correction by implantation of intraocular lens Yes service compulsory only in the case of Anisometropia greater than 10 dioptres associated with a keratotomii.
Supported only if the insurer has given prior special security and with the express permission of the medical officer.

1.1.2000/ 1.1.2005 transplant membrane amniotic fluid to cover corneal injuries Yes 1.1.2001 Photodynamic therapy of macular degeneration by infusion of Verteporfin Yes exudative macular degeneration related to age, its predominant form classic.

1.1.2006 Yes if neovascularization caused by pathologic myopia.

1.7.2000/ 1.7.2002/ 1.1.2004/ 1.1.2005/ 1.1.2006/ 1.1.2009/ 1.1.2012 no other forms of age-related macular degeneration.

1.1.2008 dilation by balloon in case of stenosis of the lacrimal canal Yes - under radiological control - with or without implantation of a stent-Interventional x-rays carried out by individuals with the appropriate experience.

1.1.2006/ 1.1.2008 ophthalmoscopy laser scanning Yes - if glaucoma is difficult to treat, to ask the indication for surgery - is the indication of the treatment of the Retineexamen in the Center where should be made the intervention and treatment.

1.1.2004/ 1.8.2008 treatment of the cornea by UV crosslinking in Keratoconus No 1.8.2008 treatment of Keratoconus with intra-corneens rings Yes for correction of astigmatism irregular if Keratoconus if a correction by glasses or contact lenses is not possible or if there is an intolerance to contact lenses.
Performance in the centres/clinics A, B and C (according to the list of centers of training of the WFH in ophthalmology).

1.8.2007 measurement of osmolarity of the tear fluid not 1.1.2010 7 Otolaryngology treatment of disorders of language Yes practice by the doctor himself or under his direction and his direct monitoring (see also art. 10 and 11 ASDS).

23.3.1972 aerosols Sonic Yes 7.3.1974 treatment by electronic ear according to the method Tomatis (audio-psycho-phonology) Yes 18.1.1979 voice prosthesis Implantation during or after a total laryngectomy.
A voice prosthesis implanted replacement is a mandatory service.

1.3.1995 laser treatment of: - epitheproliferation of the respiratory Yes 1.1.1993 - resection of the language Yes 1.1.1993 Cochlear Implant for the treatment of deafness bilateral without use of the remains of hearing Yes taking care only if the insurer has given prior special security and with the permission of the medical officer.
For children with perilinguale or postlingual deafness and for adults with late deafness. In the following centers: University cantonal Hospital of Geneva, University hospitals of Basel, Bern and Zurich, Lucerne cantonal hospital.
Auditory training provided in the Center is an integral part of the therapy to take care of.

1.4.1994/ 1.7.2002/ 1.1.2004 Implantation of hearing implant to bone conduction or their components (transcutanes and percutaneous systems) Yes Indications: - diseases and malformations of the middle ear and the external ear canal that can be corrected by surgery - only alternative to surgery at risk on the unique functional ear - Intolerance to devices to aerial transmission - replacement of a classic bone transmission device as a result of the appearance of symptoms, to an insufficient outfit or a malfunction.

1.1.1996/ 1.1.2015 Implantation in the middle ear of a system type "Vibrant Soundbridge" to deal with a deficit of hearing of the inner ear Yes Patients who for medical or audiological reasons can not use a conventional because of a chronic allergy external otitis, of an Exostosis, etc.

1.1.2005 Palatoplastie laser spraying not 1.1.1997 ptyalolithes lithotripsy Yes Execution in a centre that has the appropriate experience (minimum frequency: on average 30 first treatments per year).

1.1.1997/ 1.1.2000/ 1.1.2001/ 1.1.2004 8 Psychiatry treatment in opioid dependence Yes 1. The provisions, guidelines and recommendations: a. treatment with prescription of methadone, buprenorphine and morphine-delay: "opioid dependence: treatments based on substitution - recommendations of the federal Office of public health (FOPH), Switzerland of Medicine Society of Addiction (MASC) and the Association of cantonal doctors of Switzerland (AMCS) ' July 2013;

1.1.2001/ 1.1.2007/ 1.1.2010/ 1.7.2012


b. dealing with heroin: the provisions of the Ordinance of 25 May 2011 addiction to Narcotics (RS HYPERLINK "http://www.admin.ch/ch/f/rs/c812_121_6.html") and the guidelines and recommendations of the manual of the FOPH "treatment with prescription heroin; guidelines, recommendations, information"of September 2000.

1.1.2001/ 1.1.2007/ 1.1.2010/ 1.1.2014 2. The substance or preparation used must be on the list of drugs with price (LMT) or the list (LS) specialties in the therapeutic group (IT) approved by Swissmedic.3. Substitution treatment includes the following services: a. medical benefits:-entrance exam, including history of dependence, psychic and somatic review with particular attention to addiction-related disorders and that caused the addiction.
-requests for additional information (family, partner, previous treatment services);
-establishment of the diagnosis and indication;
-establishing a treatment plan;
-procedure of application for authorization and reporting for health insurance;
-implementation and enforcement of substitution treatment;
-discount monitored of the substance or preparation, as long as it does not come through a pharmacist;
-quality assurance;
-treatment of disorders related to the use of other psychotropic substances;
-assessment of the therapeutic process;
-requests for information from the institution in charge of the delivery of the products;
-review of the diagnosis and indication;
-adaptation of the treatment and correspondence resulting with the authorities;
-establishment of reports to the authorities and health insurance;
-quality control.
(b) the pharmacist benefits:-manufacturing oral solutions according to the LMT, including quality control;
-Reset monitored of the substance or preparation;
-keeping the accounts concerning the active substances and reporting to the authorities;
-preparation of reports for the physician in charge;
-tips.
4. delivery must be provided by the competent institution according to section 1.5. Lump sum remuneration may be agreed for substitution treatment.

25.3.1971 drug treatment - outpatient Yes Reduction of possible benefits in case of fault serious of the insured.

-Hospital Yes weaning from opioids ultra-short (CONCERN) under anesthesia General No 1.1.1998 therapy No 11.12.1980 9 9.1 radiodiagnosis tomography Radiology during axial (CT-scan) Yes No routine examination (screening).

15.11.1979 BMD-by DEXA dual energy x-ray X (DEXA) Yes-clinically manifest osteoporosis and after a fracture caused by a minimal trauma - long-term Corticotherapy or hypogonadism 1.3.1995/ 1.1.1999/ 1.7.2010/ 1.7.2012 - diseases of the digestive system with syndrome of malabsorption (especially the UC, celiac disease, Crohn disease) - hyperparathyroidism primary (when the surgical indication is not clear) - imperfect osteogenesis - HIV.

1.1.1999/ 1.7.2010/ 1.1.2015 costs by the DEXA not are supported only for the application of this measure to one region of the body.

Future reviews by the DEXA 1.3.1995 are supported only in the case of drug treatment of osteoporosis and the maximum every two years.

-by total body scanner not 1.3.1995 Osteodensitometry with peripheral quantitative CT (pQCT) No 1.1.2003/ 1.1.2006 ultrasound bone not 1.1.2003 analytical methods that apply to bony tissue: - markers of bone resorption no for the early detection of the risk of fractures related to osteoporosis 1.1.2003/ 1.8.2006 - markers of bone formation no for the early detection of the risk of fractures related to osteoporosis 1.1.2003/ 1.8.2006 Yes mammography for the diagnosis in case of strong breast pathology clinical suspicion.

1.1.2008 9.2 other methods of imaging, Nuclear Magnetic Resonance (MRI) Yes 1.1.1999 Tomography by emission of positrons (PET, PET/TC) Yes in centres that meet the administrative guidance of June 20, 2008 of the Swiss society of nuclear medicine (NMMS).

(a) by means of F-2-Fluoro-Deoxy-Glucose (FDG), only for the following indications: 1. in Cardiology:-preoperative before a heart transplant, 2. Oncology as:-according to clinical guidelines of April 28, 2011 of the NMMS, Chapter 1.0 for TEP to FDG, 3 in neurology: - as a preoperative in case of therapy-resistant focal epilepsy, - for diagnosis of dementia: as complementary in unclear cases review After screening by specialists in geriatrics, psychiatry, and Neurology; up to the age of 80, with a test Folstein (Mini Mental Status Test, MMST) of at least 10 points and dementia during 5 years maximum; not screening by PET or TEMP.

1.1.1994/ 1.4.1994/ 1.1.1997/ 1.1.1999/ 1.1.2001/ 1.1.2004/ 1.1.2005/ 1.1.2006/ 1.8.2006/ 1.1.2009/ 1.1.2011/ 1.7.2013/ 1.7.2014/ 1.1.2016 4. Being evaluated for the "mass effect" issue, according to clinical guidelines of April 28, 2011 of the NMMS, Chapter 2.0 for TEP to FDG.

1.7.2014 to the 31.12.2017 b) using N - 13 ammonia, only for the indication of the following: to examine perfusion of myocardial infarction (at rest and exercise) to assess the ischemia of the myocardium.

1.7.2013 c) addressing using rubidium 82, only for the indication of the following: for infusion of the myocardium (at rest and exercise) in view to evaluate the ischemia of the myocardium.

1.7.2013 d) using 18F-Fluorocholine, being evaluated for the following indications: for review of a demonstrated biochemical recurrence (elevation of PSA) of prostatic carcinoma.

1.7.2014 to the 31.12.2017 e) using 18F Ethyl - Thyrosine (FET) for the following indications: for purposes of assessment in the case of brain tumors and revaluation in the case of malignant brain tumors not a) with 18F-Fluorideb 1.1.2016) using 18F-Florbetapirc) with other isotopes that F-2-Fluoro-Deoxy-Glucose (FDG), 18F-Fluorocholine, N - 13 ammonia, rubidium-82 or 18F-Ethyl-Thyrosine (FET) 1.1.2013/ 1.7.2014/ 1.1.2015/ 1.1.2011/ 1.1.2016 Meg No 1.7.2002 Elastography impulse of liver Yes for the diagnosis and follow-up in case fibrosis or liver cirrhosis (e.g. by viral hepatitis, taken regular liver toxins).

1.1.2012 9.3 Interventional Radiology and radiation therapy therapeutic Irradiation by beam of pawns not 1.1.1993 therapeutic Irradiation by beam of protons Yes Execution at the Paul Scherrer Institute, Villigen.
(a) intraocular melanoma.

28.8.1986/ 1.1.1993 b) when it is not possible to conduct a sufficient irradiation by photons due to excessive beam proximity radiation-sensitive organs or the need for specific protection of the body of children and young people.
For the following indications: - tumors of the skull (clival, chondrosarcoma, Squamous Cell Carcinoma, adenocarcinoma, adenoid cystic Carcinoma, lymphoepithelioma, carcinoma mucoepidermoide, esthesioneuroblastoma, soft tissue sarcomas and osteosarcomas, carcinomas not differentiated, rare such as the paragangliomes tumors) - tumors of the brain and the meninges (low grade gliomas, 1 or 2; meningiomas) - tumors extra-craniennes at the level of the spine, the trunk and ends (soft tissue and bone sarcomas) - tumors of the child and adolescent support only if the insurer has previously given a guarantee special and with the express permission of the medical officer.

1.1.2002/ 1.7.2002/ 1.8.2007/ 1.1.2011/ 1.7.2011 Non - radiotherapy of postoperative cancer of the breast - all other 1.7.2012/ 15.7.2015 radiosurgery (gamma knife, LINAC) Yes Indications indications: - the acoustic nerve Neuroma - recurrence of adenoma pituitary or cranio-pharyngiome - pituitary adenoma or cranio-pharyngiome, if surgical removal is not possible - arteriovenous malformation-Meningioma 1.1.1996 Yes in case of functional disorders, including: pain syndrome (e.g., trigeminal neuralgia) (, cluster headache of the face), movement disorders (e.g., essential tremor, Parkinson's disease), epilepsy (e.g., temporal epilepsy, Hamartoma associated with epilepsy, epilepsy extra-temporale) 1.1.1996/ 1.7.2012 radiosurgery LINAC Yes - brain metastases of a maximum volume of a diameter not exceeding not 3.5 cm or 25 cm, if there is a maximum of 3 metastasis and primary disease is well controlled (not provable systemic metastases) , in case of pain resistant to any other therapy; - primary malignant tumours of a volume of maximum of 25 cm or not exceeding a diameter of 3.5 cm, where the location of the tumor does not allow to operate.

1.1.1999/ 1.1.2000/ by gamma knife radiosurgery 1.1.2003 no


-brain metastases of a maximum volume of 25 cm and a diameter not exceeding 3.5 cm, if there is a maximum of 3 metastasis and primary disease is well controlled (no), in case of any other therapy-resistant pain; - primary malignant tumours of a volume of maximum of 25 cm or not exceeding a diameter of 3.5 cm When the location of the tumor does not operate.

1.1.1999/ 1.1.2000/ 1.4.2003/ 1.7.2011 Implantation of markers in gold Yes for the treatment of prostate by marking 1.8.2008 Injection of hydrogel made from polyethylene glycol as no device of estrangement between the prostate and rectum in the case of radiotherapy of prostate 1.7.2012/ 1.7.2014 selective interstitial radiation therapy (SIRT) using microspheres in resin loaded with yttrium 90 Yes in the case of tumors inoperable liver and resistant to chemotherapy for which a local ablation is not possible or remained without effect.
Achievement in an interdisciplinary hepato-biliary Center including a consultation service ad hoc (specialized hepato-biliary surgery, interventional radiology, nuclear medicine and medical oncology).

1.7.2010 embolization of fibroids of the uterus Yes by specialists in radiology attesting to an experience of the technique of Interventional x-rays.
Modern angiographic system.

1.1.2004/ 1.1.2005/ 1.1.2010/ 1.1.2011/ percutaneous Discectomy 1.1.2013 by fluoroscopy and control CT No 1.1.2014 transperineale Implantation of a biodegradable balloon no spacer device between the prostate and rectum if percutaneous irradiation of prostate.

1.1.2015 10 complementary medicine Acupuncture Yes practice by doctors hold proof of additional training in acupuncture issued according to the programme of further training on 1 January 1999 'Acupuncture and traditional Chinese medicine (ASA)', revised February 24, 2005.

1.7.1999/ 1.1.2012 anthroposophic medicine Yes ongoing evaluation performed by attendings proof of additional training in anthroposophical medicine issued in accordance with the program of training of 1 January 1999 "practitioner (ne) for a medicine expanded by anthroposophy (ASMOA) ', revised September 28, 2006.

1.7.1999/ 1.1.2005/ 1.7.2005/ 1.1.2012 until the 31.12.2017 therapy of Chinese traditional medicine Yes course evaluation performed by licensed doctors of proof of additional training in drug therapy of TCM issued in accordance with the training program complementary to 1 January 1999 'Acupuncture and traditional Chinese medicine (ASA)', revised February 24, 2005.

1.7.1999/ 1.1.2005/ 1.7.2005/ 1.1.2012 until 31.12.2017 unicist Homeopathy (classical) Yes under evaluation by attendings proof of additional training in homeopathy issued in accordance with the program of training of 1 January 1999 "Homeopathy (SSMH) ', revised September 14, 2008.

1.7.1999/ 1.1.2005/ 1.7.2005/ 1.1.2012 until the 31.12.2017 herbal medicine Yes in course evaluation performed by licensed doctors of proof of additional training in herbal medicine issued in accordance with the programme of further training from July 1, 2011.

1.7.1999/ 1.1.2005/ 1.7.2005/ 1.7.1999/ 1.1.2012 until the neural therapy according to Huneke No 1.7.1999/ 1.1.2005/ 1.7.2005/ 1.7.1999/ 1.1.2012/ 1.7.2012 31.12.2017 11 rehabilitation hospital rehabilitation Yes support only if the insurer has given prior special security and with the express permission of the medical officer.

Rehabilitation of patients 1.1.2003 suffering cardiovascular disease or diabetes support only if the insurer has previously given special security and with the express permission of the medical officer.
Rehabilitation in case of main diagnosis of a peripheral arterial disease (MAP) and diabetes will be held ambulatoirement. Cardiovascular rehabilitation can be the subject of ambulatory or hospital treatment. For hospital treatment: - a high heart risk - a myocardial insufficiency - a comorbidity (diabetes mellitus, COPD, etc.).

The outpatient treatment lasts from two to six months depending on the intensity of the treatment required.
The duration of hospital treatment is generally of four weeks, but in simple cases, can be reduced to two or three weeks.
Rehabilitation is practiced in an institution run by a doctor. The program, staff and infrastructure must meet the following requirements: cardiac rehabilitation: profile indicated by the Working Group for the cardiac rehabilitation of the Swiss society of Cardiology (GSRC, /institutions rehabilitation clinics recognized officially by the GSRC) March 15, 2011.
Rehabilitation in the case of MAP: profile indicated by the Swiss society of Angiology on March 5, 2009.
Rehabilitation in diabetes: profile indicated by the Swiss society of Endocrinology and diabetology on November 17, 2010.

12.5.1977/ 1.1.1997/ 1.1.2000/ 1.1.2003/ 1.1.2009/ 1.7.2009/ 1.1.2010/ 1.7.2011 1.1.2013 Indications: Yes-Patients having a heart attack myocardial infarction, with or without - PTCA Patients having undergone a bypass surgery-Patients who have experienced other interventions at the level of the heart or of the big vessels-Patients after PTCA, especially after a period of inactivity and/or with multiple factors of risk-Patients suffering from chronic heart disease and with multiple factors of refractory to therapy risk but having a good hope of life - patients suffering from chronic heart disease and poor ventricular function - Patients with a diabetes mellitus type II (limitation: at most once in three years).

Yes - Patients with peripheral arterial disease (MAP) from the stage IIa according to Fontaine 1.7.2009/ 1.1.2013 Non - Patients suffering from a peripheral arterial disease (MAP) in stage I according to Fontaine.

1.7.2013 pulmonary rehabilitation Yes programs for patients suffering from severe chronic lung diseases.
The therapy can be performed on an outpatient basis or in an institution run by a doctor. The program, staff and infrastructure must correspond to the indications made in 2003 by the Commission of the Swiss society of Pneumology pulmonary rehabilitation.
The program director must be recognized by Swiss Pneumology society, the Commission of pulmonary rehabilitation and training of patients support once a year maximum.
Supported only if the insurer has given prior special security and with the express permission of the medical officer.

1.1.2005 new content according to chapter II al. 1 o of the DFI on Nov. 9. 2005 (RO 2006 23). Updated by clause II of the O of the DFI on 3 July. 2006 (RO 2006 2957), c. II al. 1 o of the DFI on Dec. 20. 2006 (RO 2006 5769), June 28, 2007 (RO 2007 3581), Nov. 21. 2007 (RO 2007 6839), June 26, 2008 (RO 2008 3553), Dec 10. 2008 (RO 2008 6493), June 5, 2009 (RO 2009 2821), of 27 October. 2009 (RO 2009 6083), June 14, 2010, (RO 2010 2755), section I of the O of the DFI on August 16, 2010 (RO 2010 3559), ch. II al. 1 o of the DFI on Dec. 2. 2010 (RO 2010 5837), May 31, 2011 (RO 2011 2669), Dec 5. 2011 (RO 2011 6487), of June 12, 2012 (2012 3553 RO), from 15 nov. 2012 (2012 6587 RO), June 10, 2013 (2013 1925 RO), Dec 6. 2013 (2013 5329 RO), May 16, 2014 (RO 2014 1251), nov 20. 2014 (RO 2014 4393), 17 June 2015 (RO 2015 2197) and Nov. 27. 2015, in force since Jan. 1. 2016 (2015 5125 RO).
The document can be accessed at the following address: www.ofsp.admin.ch > Themes > health insurance > enforcement and legal basis > law > Documents of reference related to the ASD and its annexes.
RS 810.21 RS 810.211 the document can be consulted at the following address: www.ofsp.admin.ch > Themes > health insurance > enforcement and legal basis > law > Documents of reference related to the ASD and its annexes.
The document can be accessed at the following address: www.ofsp.admin.ch > Themes > health insurance > enforcement and legal basis > law > Documents of reference related to the ASD and its annexes.
The document can be accessed at the following address: www.ofsp.admin.ch > Themes > health insurance > enforcement and legal basis > law > Documents of reference related to the ASD and its annexes.
The document can be accessed at the following address: www.ofsp.admin.ch > Themes > health insurance > enforcement and legal basis > law > Documents of reference related to the ASD and its annexes.
The document can be accessed at the following address: www.ofsp.admin.ch > Themes > health insurance > enforcement and legal basis > law > Documents of reference related to the ASD and its annexes.
RS 810.21 RS 810.211 the document can be consulted at the following address: www.ofsp.admin.ch > Themes > health insurance > enforcement and legal basis > law > Documents of reference related to the ASD and its annexes.
The document can be accessed at the following address: www.bag.admin.ch/ref the document can be accessed at the following address: www.bag.admin.ch/ref

The document can be accessed at the following address: www.ofsp.admin.ch > Themes > health insurance > enforcement and legal basis > law > Documents of reference related to the ASD and its annexes.
The document can be accessed at the following address: www.ofsp.admin.ch > Themes > health insurance > enforcement and legal basis > law > Documents of reference related to the ASD and its annexes.
The document can be accessed at the following address: www.ofsp.admin.ch > Themes > health insurance > enforcement and legal basis > law > Documents of reference related to the ASD and its annexes.
The document can be accessed at the following address: www.ofsp.admin.ch > Themes > health insurance > enforcement and legal basis > law > Documents of reference related to the ASD and its annexes.
The document can be accessed at the following address: www.ofsp.admin.ch > Themes > health insurance > enforcement and legal basis > law > Documents of reference related to the ASD and its annexes.
The document can be accessed at the following address: www.ofsp.admin.ch > Themes > health insurance > enforcement and legal basis > law > Documents of reference related to the ASD and its annexes.
The document can be accessed at the following address: www.ofsp.admin.ch > Themes > health insurance > enforcement and legal basis > law > Documents of reference related to the ASD and its annexes.
The document can be accessed at the following address: www.ofsp.admin.ch > Themes > health insurance > enforcement and legal basis > law > Documents of reference related to the ASD and its annexes.
The document can be accessed at the following address: www.ofsp.admin.ch > Themes > health insurance > enforcement and legal basis > law > Documents of reference related to the ASD and its annexes.
The document can be accessed at the following address: www.ofsp.admin.ch > Themes > health insurance > enforcement and legal basis > law > Documents of reference related to the ASD and its annexes.
The document can be accessed at the following address: www.ofsp.admin.ch > Themes > health insurance > enforcement and legal basis > law > Documents of reference related to the ASD and its annexes.
The document can be accessed at the following address: www.ofsp.admin.ch > Themes > health insurance > enforcement and legal basis > law > Documents of reference related to the ASD and its annexes.
The document can be accessed at the following address: www.ofsp.admin.ch > Themes > health insurance > enforcement and legal basis > law > Documents of reference related to the ASD and its annexes.
The document can be accessed at the following address: www.ofsp.admin.ch > Themes > health insurance > enforcement and legal basis > law > Documents of reference related to the ASD and its annexes.
The document can be accessed at the following address: www.ofsp.admin.ch > Themes > health insurance > enforcement and legal basis > law > Documents of reference related to the ASD and its annexes.
The document can be accessed at the following address: www.ofsp.admin.ch > Themes > health insurance > enforcement and legal basis > law > Documents of reference related to the ASD and its annexes.
The document can be accessed at the following address: www.ofsp.admin.ch > Themes > health insurance > enforcement and legal basis > law > Documents of reference related to the ASD and its annexes.
The document can be accessed at the following address: www.bag.admin.ch/ref the document can be accessed at the following address: www.bag.admin.ch/ref the document can be accessed at the following address: www.ofsp.admin.ch > Themes > health insurance > enforcement and legal basis > law > Documents of reference related to the ASD and its annexes.
The document can be accessed at the following address: www.ofsp.admin.ch > Themes > health insurance > enforcement and legal basis > law > Documents of reference related to the ASD and its annexes.
The document can be accessed at the following address: www.ofsp.admin.ch > Themes > health insurance > enforcement and legal basis > law > Documents of reference related to the ASD and its annexes.
The document can be accessed at the following address: www.ofsp.admin.ch > Themes > health insurance > enforcement and legal basis > law > Documents of reference related to the ASD and its annexes.
The document can be accessed at the following address: www.ofsp.admin.ch > Themes > health insurance > enforcement and legal basis > law > Documents of reference related to the ASD and its annexes.
The document can be accessed at the following address: www.ofsp.admin.ch > Themes > health insurance > enforcement and legal basis > law > Documents of reference related to the ASD and its annexes.
The document can be accessed at the following address: www.ofsp.admin.ch > Themes > health insurance > enforcement and legal basis > law > Documents of reference related to the ASD and its annexes.
The document can be accessed at the following address: www.ofsp.admin.ch > Themes > health insurance > enforcement and legal basis > law > Documents of reference related to the ASD and its annexes.

Status January 1, 2016 annex 2 (art. 20A) list of means and devices (LiMA) not published in the RO (RO 2009 2821 6083, 2010-2755-5837, 2011 2669 6487, 2012 3553 6587, 5329 2013, 2014 1251 4393, 2015 2197 5125). The list can be found on the site of the FOPH to the following address: www.ofsp.admin.ch > Themes > health insurance > rates and prices > list of means and devices.

Annex 3 (art. 28) January 1, 2016 list analyses not published in the RO (RO 2009 1669 3173 6083, 2010-2755-5837, 2011 2669 6487, 2012 3553 4347 6587, 2013 5329, 2014 1251 3487 4393, 2015-2197-5125). The list can be found on the site of the FOPH to the following address: www.ofsp.admin.ch > Themes > health insurance > list of the LCA.

Status January 1, 2016 annex 4 (art. 29) list of drugs with price not published in the RO (RO 2005 2875). The annex and its mod. can be found on the site of the FOPH to the following internet address: www.ofsp.admin.ch > Themes > health insurance > rates and prices.

Status January 1, 2016

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