Key Benefits:
On 26 September 2014 (State 1 Er January 2016)
1 This Act regulates the supervision of the Confederation in the field of social insurance on:
2 In particular, it aims to protect the interests of insured persons in accordance with the LAMal, in particular by guaranteeing the transparency of social insurance and the solvency of sickness insurance.
1 The disease caissae are legal persons of private or public non-profit law who practice social insurance in the sense of the LAMal 1 .
2 In addition to social health insurance within the meaning of the LAMal, the sickness insurance scheme has the right to practise supplementary insurance; it may also practice other insurance branches, under the conditions and within the limits set by the Federal Council. All such insurance is governed by the Act of 2 April 1908 on the insurance contract 2 .
3 Sickness insurance may also be subject to accident insurance within the limits set out in s. 70, para. 2, of the Federal Act of 20 March 1981 on accident insurance 3 .
1 The supervisory authority shall authorise insurers within the meaning of Art. 2 and 3 (insurers) who meet the requirements of this Act and which guarantee the interests of insured persons in the practice of social insurance.
2 It publishes the list of insurers admitted.
Insurers must meet the following conditions:
1 RS 832.10
1 The insurer may delegate tasks to another entity in its insurance group, to a federation of insurers or to third parties.
2 It cannot delegate:
3 The insurer must ensure that supervision over the tasks it delegates can be exercised without restriction.
1 The application for authorisation shall be submitted to the Supervisory Authority.
2 It must be accompanied by an operating plan. It should contain the following information and documents:
3 The supervisory authority may request the other information and documents necessary for it to decide on the application.
1 Any modification of the elements of the business plan referred to in s. 7, para. 2, let. A, i or k to n, requires the authorization of the Supervisory Authority.
2 Any modification of the elements of the business plan referred to in s. 7, para. 2, let. B to f, j, o or p must be communicated before the supervisory authority. An amendment shall be deemed to have been authorised if the supervisory authority does not initiate a review procedure within eight weeks of the communication.
1 The insurer intends to change its legal structure or to operate a transfer of assets within the meaning of the Act of 3 October 2003 on the merger 1 Communicates it to the supervisory authority.
2 The supervisory authority may, within eight weeks of the communication, prohibit a change or subject it to conditions where its nature or its importance is likely to be detrimental to the insurer or to harm the insurer The interests of the insured.
3 An insurer that intends to transfer all or part of its workforce of insured persons to another insurer under an agreement must obtain the authorization of the supervisory authority. It allows for the transfer if it allows the interests of insured persons as a whole to be safeguarded.
1 An insurer that intends to take an interest in another business must notify the supervisory authority when that interest has reached or exceeds 10, 20, 33 or 50 % of the capital or voting rights of the other business.
2 Any person who intends to take, directly or indirectly, an interest in an insurer must inform the supervisory authority where such interest has reached or exceeds 10, 20, 33 or 50 % of the capital or voting rights of the insurer.
3 Any person who intends to reduce his or her participation in an insurer below the thresholds of 10, 20, 33 or 50 % of the capital or voting rights or to change its participation in such a way that the insurer ceases to be its subsidiary shall inform the authority of the Monitoring.
4 The supervisory authority may prohibit participation or subject it to conditions where its nature or its importance may be detrimental to the insurer or adversely affect the interests of insured persons.
Insurers fund social insurance through the application of the needs coverage system.
1 Insurers are appropriate technical provisions.
2 Technical provisions include provisions to cover the costs of past salaries that have not yet been charged, provisions for insurance cases that have not yet been invoiced in the optional insurance Of daily allowances and, if the premiums are staggered according to the age of entry, the provisions for the ageing of the optional daily allowance insurance.
1 In the field of social insurance, insurers are sufficient reserves to guarantee their solvency.
2 The Federal Council regulates the calculation of the minimum level of reserves or solvency. It is based on insurance risks, market risks and credit risks to which the insurer is exposed for all its activities.
1 Insurers constitute a related capital of social insurance intended to guarantee the obligations arising from the insurance reports and the reinsurance contracts they have entered into. They provide evidence to the supervisory authority each year and may request such proof at any time.
2 The debit of the related fortune of social health insurance corresponds to the technical provisions of insurance.
3 Property allocated to the related capital of social insurance must be designated as such. They can only fulfil obligations that social health insurance is intended to guarantee.
1 The premium rates for compulsory insurance and optional individual insurance for daily allowances shall be subject to the approval of the Supervisory Authority. They shall not be made public nor shall they be applied before their approval.
2 The supervisory authority verifies that the rates guarantee the solvency of the insurer and the interests of insured persons in the sense of LAMal 1 .
3 The insurer's premiums cover the specific costs of the cantons. The insured person's place of residence is determinative. The insurer takes into account, among other things, the compensation of risks, variations in provisions and the size and permanent evolution of the insured population in the canton.
4 The Supervisory Authority does not approve tariffs where premiums are:
5 If it does not approve the tariffs, the supervisory authority shall order the measures to be taken.
6 Prior to the approval of tariffs, the cantons may give their opinion to insurers and to the supervisory authority on the assessment of costs for their territory, provided that such exchanges do not prolong the approval procedure. The cantons may obtain the necessary information from insurers and the supervisory authority. Such information shall not be made public nor shall it be transmitted to third parties.
7 If the rates are approved for less than one year, the supervisory authority requires that the insurer make public with the publication of the tariffs the duration of the rate approval.
1 If, in a canton, the premiums received by an insurer for a given year were substantially higher than the cumulative costs in that canton, the insurer may, in the canton concerned, offset the premiums the following year. The amount of the compensation must be clearly indicated and justified by the insurer in the application for approval. It must be filed with the supervisory authority no later than the end of June of the following year.
2 Premium compensation should, in principle, restore the balance between premiums and costs.
3 In order to assess the appropriateness of the compensation for premiums, the supervisory authority is based on the ratio between the costs and premiums of the insurer. It takes into account the compensation of risks, variations in provisions and the size and permanent evolution of the number of insured persons in the canton. It also takes into account the overall economic situation of the insurer.
4 The Federal Council shall issue the necessary implementing provisions concerning the compensation of premiums. He intends to do so by the insurers.
The rebate is in the form of a rebate granted by the insurer to persons insured with the insurer on December 31 of the year for which the premiums are refunded. It is made during the calendar year in which the application was filed.
1 Insurers must bear the cost of administering social insurance within the limits of economic management. Administrative costs include the costs of intermediaries and advertising expenses.
2 In its annual accounts, the insurer certifies separately the advertising expenses and the commissions paid to intermediaries.
3 Insurers may enter into an agreement to settle the telephone market, the abandonment of services provided by call centres, and the limitation of the compensation of intermediaries.
1 The members of the administrative and management bodies of an insurer and the members of the joint institution must have a good reputation and offer the guarantee of an irreproachable activity.
2 The Federal Council shall determine the professional qualifications which these persons must present.
3 The President of the Administrative Body may not preside over the Governing Body.
4 The Federal Council lays down provisions on the publication of interest links and the prevention of conflicts of interest.
1 Insurers present their compensation system in the management report.
2 They publish in the management report:
3 The insurers set out in the management report the reasons why the amounts of the allowances changed from the previous year.
4 Benefits include:
1 Insurers are organised in such a way as to be able, in particular, to identify, limit and control all major risks.
2 The Federal Council lays down provisions on the objective of risk management, its content and related documents and on the monitoring of risks by insurers.
1 Insurers put in place an effective internal control system that is efficient and responsive to the size and complexity of the business. They mandate an internal review body independent of management.
2 The internal review body shall establish at least once a year an activity report and deliver it to the external review body.
1 Insurers shall establish on 31 December of each year a management report consisting of the annual accounts, the annual report and, where the code of obligations (CO) 1 The group's accounts.
2 They submit their management report on the last fiscal year to the supervisory authority no later than April 30. The decision of the competent body of the Insurer concerning the approval of the accounts may be issued at a later date, no later than 30 June.
3 The supervisory authority may request interim reports.
4 The Federal Council shall lay down the provisions relating to the establishment of accounts. It sets out the requirements to which the reports submitted to the supervisory authority in accordance with paras. 1 to 3 must meet; it may set specific requirements for the management report. It may delegate these powers to the supervisory authority.
1 Insurers appoint an approved external review body to carry out the following tasks:
2 Only review undertakings approved as auditors within the meaning of the Act of 16 December 2005 on the supervision of the revision 2 May be mandated.
3 Only a natural person who is certified as a review officer within the meaning of the Review Supervision Act may exercise the task of the Review Officer who directs the review.
1 The external review body reviews:
2 The supervisory authority may assign additional mandates to the external review body and order specific controls. In the event of an index of irregularities or illegal acts, the costs shall be borne by the insurer.
3 The external review body shall record the results of its audits and its findings in a report within the meaning of s. 728 B CO 2 He shall deliver this report to the supervisory authority no later than 30 April.
The external review body shall immediately inform the supervisory authority when it finds:
1 The supervisory authority shall authorise a reinsurer to practice the reinsurance of the risks of social insurance if it fulfils the requirements of this Law and guarantees the interests of insured persons.
2 It publishes the list of reinsurers allowed to practice.
1 Reinsurance may be carried out:
2 Reinsurers must meet the following conditions:
1 The application must be submitted to the supervisory authority.
2 It must be accompanied by an operating plan. It should contain the following information and documents:
3 The business plan of the private reinsurer should contain the following information and documents in addition:
4 The supervisory authority may request the other information and documents necessary for it to decide on the application.
Any changes to the operating plan items should be communicated to the monitoring authority.
The Federal Council sets the minimum share of insurance risks that insurers must assume for themselves.
1 Reinsurance premiums must correspond to the risks assumed. They are subject to the approval of the Supervisory Authority.
2 Reinsurers shall submit each year to the Supervisory Authority the estimated profit and loss accounts for the reinsurance business in respect of social insurance and a statement for each reinsurance contract.
1 The supervisory authority controls the practice of social insurance. In particular, it performs the following tasks:
2 The supervisory authority shall ensure that insurers fulfil the conditions of authorisation laid down by law in a sustainable manner. If the conditions are no longer met, it requires the restoration of the legal order.
3 It may give instructions to insurers for the uniform application of federal law and carry out inspections of them. These inspections may be carried out without prior notice. In these cases, the supervisory authority must have free access to all the information it deems relevant.
4 It may at any time entrust third parties to verify that this Law is complied with. The costs may be borne by the undertaking concerned if the control reveals irregularities or illegal acts. Money orders are not required to maintain secrecy with respect to the supervisory authority.
5 FINMA monitors the practice of insurance under s. 2, para. 2, pursuant to the ICA 2 The Supervisory Authority and FINMA coordinate their monitoring activities. They shall inform themselves as soon as they are aware of important facts for the other supervisory authority.
1 Monitored enterprises are required to provide the supervisory authority, the external review body or the persons authorised by the supervisory authority with all the information and documents necessary to carry out the monitoring of the Social health insurance.
2 They are required to provide the supervisory authority with information on data related to their social health insurance activities each year. The Supervisory Authority may request such indications several times a year.
3 Insurers must immediately notify the supervisory authority of the facts that are of great importance to the supervision.
1 Notwithstanding s. 33 LPGA 1 , the supervisory authority may, in the field of social health insurance, transmit to other Swiss supervisory authorities and to the cantons information and documents which are not accessible to the public they need to carry out their Tasks.
2 The administrative and judicial authorities of the Confederation and the cantons are obliged, subject to specific legal provisions, to cooperate in the verification of the supervisory authority and, on written and reasoned request, to Provision of necessary documents. Administrative assistance should be granted without charge.
1 Where an insurer does not comply with the provisions of this Act or the LAMal 1 Or fails to comply with the instructions of the supervisory authority or where the interests of the insured appear to be threatened in any other way, the supervisory authority shall take the provisional measures which it considers necessary for Safeguard the interests of policyholders.
2 In particular, the supervisory authority may:
3 If the situation of an insurer is compromised and the statutory bodies have not taken adequate measures, the supervisory authority may take the measures provided for in para. 2, let. G and h, to ensure compliance with legal requirements for the following two years.
1 The supervisory authority may appoint an independent expert in the implementation of supervision measures within the meaning of s. 38 that she ordered.
2 It defines the tasks of its delegate. It determines the extent to which it can act in the place of the organs of the monitored enterprise.
3 Art. 35 applies by analogy to the information skills of the delegate and to the obligation of the supervised companies to provide information.
4 The expenses of the delegate are the responsibility of the company being monitored. At the request of the Supervisory Authority, the Supervisory Authority shall pay a fee advance. The Supervisory Authority may exceptionally grant a total or partial exemption from these costs.
1 In preparing for the transfer of the insured's workforce, the supervisory authority is unbound by its obligation to keep the secret to insurers and federations of interested insurers.
2 It may transfer to another insurer, subject to its agreement, all or part of the insured's workforce of an insurer, with its associated capital of social health insurance, its reserves and the rights and obligations relating to them. It lays down the conditions for transfer by decision.
1 The opening of the bankruptcy of an insurer is subject to the authorisation of the supervisory authority. Permission is granted if there is no opportunity for remediation .
2 The supervisory authority may apply to the bankruptcy court for the opening of the bankruptcy of a caisse-sickness.
1 The Federal Council may, in order to overcome a temporary liquidity shortage, grant the common institution a cash-flow loan under market conditions. The guarantee of this loan may be subject to conditions.
2 In order to guarantee the repayment of the cash loan within five years, the Federal Council may decide on a premium of 1 % at most on the volume of the compulsory insurance premiums for the benefit of the insolvency fund.
1 The supervisory authority withdraws to the insurer the authorisation to practise social insurance and the reinsurer the authorisation to practice reinsurance in the field of social insurance if they request it or if they do not Plus legal requirements.
2 If the authorisation is completely withdrawn and the assets and staff of the insured persons are not transferred by agreement to another insurer, the amount, if any, of the capital of the insurers shall be paid to the insolvency fund of the joint institution.
3 If the supervisory authority withdraws to an insurer the authorisation to practice compulsory health insurance only for certain parts of its territorial field of activity, the insurer must assign a share of its reserves. This amount is divided between the insurers who resume the insured persons affected by the limitation of the territorial scope of activity. The supervisory authority may fix the amount and allocate its allocation to the joint institution.
4 If an insurer or reinsurer ceases its insurance business, the supervisory authority makes a decision on the release of the supervision.
5 The Supervisory Authority shall communicate its decision to the Office of the Trade Register and shall publish it at the expense of the undertaking.
1 The supervisory authority may audit transactions between a social insurance company and other companies.
2 The monitoring authority may delegate this audit to the external review body.
3 The supervisory authority may lay down provisions on risk management and the internal control system provided that insurers are concerned.
4 Art. 20 (guarantee of irreproachable activity) and 38, par. 2, let. F (revocation of persons), shall apply mutatis mutandis to the holding company.
5 With regard to para. 1 et al. 3, the obligation to provide information under s. 35 shall apply mutatis mutandis to the holding company.
The Joint Institution shall mandate an external review body. Art. 25 to 27 are applicable by analogy.
The Joint Institution shall submit to the Supervisory Authority an annual report on its activity no later than 30 June of the following year. The following documents are attached:
The Joint Institution shall manage an insolvency fund intended to cover the costs of legal benefits in place of insolvent insurers, in accordance with Art. 18, para. 2, LAMal 1 .
The insolvency fund is financed from the following sources:
The common institution shall determine the amount of the insolvency fund.
1 An insurer is insolvent if a judicial liquidation procedure is opened against it or it will no longer be able to fulfil its financial obligations in the near future.
2 The supervisory authority shall formally determine the insolvency of the insurer at the request of the insurer at the request of the joint or ex officio institution. It shall set at the same time the time at which the insolvency fund has an obligation to allocate benefits and shall inform the joint institution.
1 The common institution shall, at the rate of the insolvency fund, take charge of the amount that is missing from the insolvent insurer in order to pay the legal benefits. These include the following fees:
2 The common institution rule on a case-by-case basis is the appropriate way to provide benefits.
3 It shall communicate to the administration of the liquidation or the bankruptcy the amount of the benefits paid by the insolvency fund. The benefits announced are treated as receivables from liquidation or bankruptcy.
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2 RS 832.10
1 The common institution shall assume, vis-à-vis a body or a third party responsible for the insolvency of the insurer, the claims of the insurer in competition with the legal benefits which the insolvency fund has taken care of in its place. It produces its claims in the bankruptcy procedure.
2 Where there are several officials, they shall respond jointly to the common institution.
3 The limitation periods applicable to the rights of the injured insurer are also applicable to the rights which have passed to the common institution. In the case of the joint institution's claims, they do not start to run until the common institution has been aware of the benefits to be allocated and the person responsible.
4 The product of the claims serves, after deduction of recovery costs, to cover the amount assumed by the insolvency fund under s. 51. The balance is paid to the bankrupt estate.
5 Claims that do not go to the common institution remain in the bankrupt estate.
1 A person shall be punished with a custodial sentence of up to three years or of a pecuniary penalty, wilfully:
2 If the author acts by negligence, he shall be punished with a pecuniary penalty of up to 180 days.
1 A fine of up to 500 000 francs is imposed on anyone, intentionally:
2 If the author acts negligently in the cases referred to in para. 1, it shall be punished by a fine of not more than 150,000 francs.
3 A fine of up to 100 000 francs is imposed on anyone, intentionally:
4 If the author acts negligently in the cases referred to in para. 3, let. B to f, he is liable to a fine of not more than 20 000 francs.
5 Information obtained by the supervisory authority or the authorised person through the cooperation of a person may be used against the person in a criminal procedure only if the person concerned gives his or her consent or Information could have been obtained without his or her cooperation.
The competent authority may waive the prosecution of the punishable persons and order the undertaking to pay the fine if the following conditions are met:
The Federal Office of Public Health shall exercise supervision within the meaning of this Law.
The Federal Council shall execute this Law. It lays down the implementing provisions.
The amendment of other acts is set out in the Annex.
1 Insurers shall implement the following provisions within two years of the coming into force of this Act:
2 They shall implement the following provisions within five years of the coming into force of this Act:
Whatever the order in which the modification of March 21, 2014 1 Of the LAMal 2 And this Law shall enter into force, upon the entry into force of the second of those laws or upon their entry into force simultaneously, s. 51, para. 1, let. C, has the following content:
Article 51, para. 1, let. C
1 The common institution shall, at the rate of the insolvency fund, take charge of the amount that is missing from the insolvent insurer in order to pay the legal benefits. These include the following fees:
(art. 58)
The following acts are amended as follows:
... 1
1 The mod. Can be viewed at RO 2015 5137 .
