832.121 order on the monitoring of the social health insurance (Ordinance on the supervision of insurance, OSAMal) of November 18, 2015 (Status January 1, 2016) the federal Council Swiss, view the art. 2, al. 2, 14, al. 2: 17, al. 4: 20, al. 2 and 4, 22, al. 2: 24, al. 4, 32 and 57 of the Federal law of September 26, 2014, on the monitoring of the social health insurance (LSAMal), stop: Chapter 1 Definitions article 1. other insurance lines are considered to be other branches of insurance within the meaning of art. 2, al. 2, LSAMal: a. a death because of illness or accident of 6000 francs at most; b. the maintenance of compulsory insurance for care within the meaning of art. 7A of the Ordinance of 27 June 1995 on health insurance (OAMal).
SR 832.102 art. Insurance 2 group two enterprises or more form an insurance group if the following conditions are met: a. the activity they perform globally in the field of insurance is predominant; b. they form an economic unit or are interrelated on the basis of factors of influence or control.
Chapter 2 permission to practice the social insurance art. 3 approval the application for authorization to practice social insurance within the meaning of art. 7 LSAMal must be submitted to the supervisory authority on 30 June at the latest of the year before where the insurer intends to practice the social health insurance for the first time.
The private insurance companies should attach to their application the evidence that they have approval to carry their insurance activity in accordance with the Act of December 17, 2004 on the monitoring of insurance.
RS 961.01 art. 4 exemption of the obligation referred to in art. 5, let. g, LSAMal an insurer may exceptionally be exempted from all or part of the obligation to offer the people obliged to ensure who reside in a Member State of the European Union, Iceland or Norway the opportunity to join the social health insurance if the following conditions are met: a. There are fewer than 500,000 policyholders; b. He doesn't want to practice the social health insurance in any of these States or only part of them; c. its workforce of insureds in the States in question are very important.
He must present a request for exemption to the supervisory authority June 30 at the latest. The exemption takes effect on 1 January of the following year.
Art. 5 start of the validity of the authorization the authorization to practice the social health insurance takes effect at the beginning of a calendar year.
Art. 6 withdrawal of the authorization in the absence of insurance activity if an insurer has no insured for two years, the business of insurance is deemed to be completed. The supervisory authority withdraws its authorization to practice the social health insurance and releases the oversight.
Art. 7 times in the case of modification of the operating plan applications for modification of the territorial scope of activity, new provisions on specific forms of insurance in the compulsory care insurance and voluntary insurance of daily allowances as well as the General conditions of insurance must be submitted to the supervisory authority five months before the start of their validity. The supervisory authority may shorten this delay.
Contracts or other agreements to delegate important tasks such as benefits, recovery control, accounting and management of the fonts must be handed over to the supervisory authority two months before the start of their validity.
Art. 8 changes in the legal structure, transfer of assets and transfer of membership of policyholders the insurer which intends to make a change within the meaning of art. 9, al. 1, LSAMal, must inform the supervisory authority on 30 June at the latest. Communication and the corresponding documents must be submitted to the supervisory authority on 30 August at the latest. The changes take effect January 1.
The insurer which intends to make a change within the meaning of art. 9, al. 3, LSAMal, must communicate it to the authority at least four months before the date of transfer.
In the circumstances, the supervisory authority may: a. shorten the period provided for in art. 9, al. 2, LSAMal and the time frame referred to in paras. 1 and 2, provided that a shorter period is in the interest of policy holders and their rights; b. allow the changes referred to in para. 1 take effect on a date other than January 1.
Chapter 3 financing of activity of Insurance Section 1 Reserves art. 9 initial reserves the insurer seeking permission to practice the social health insurance must have reserves of at least eight million francs.
Art. 10 determination of reserves the insurer determines reserves by calculating the difference between the value of the assets and the value of commitments.
The assets must be valued at the market value. For the assets, this value is the market value; If it is unavailable, it corresponds to the market value of comparable assets or is determined by a recognized method of financial mathematics.
The value of the commitments must be evaluated as exactly as possible according to recognized actuarial methods.
The positions of the balance sheet insurance within the meaning of the Federal Act of 2 April 1908 on insurance contract (LCA) are not taken into account when calculating the value of the assets and the value of commitments.
The federal Department of Home (Affairs FDHA) can define how the assets and liabilities are evaluated.
SR 221.229.1 art. 11 minimum level of reserves reserves must reach a level at least sufficient to make the average of the possible reserves at the end of the year that are below the threshold value is zero. The threshold value is the value that the reserves will exceed one year with a probability of 99%.
The DFI sets a model for the calculation of the minimum level of reserves. This model includes: a. the quantification of actuarial risk, market risk and credit risks; b. assessment of scenarios regarding the actuarial risk, market risk and the credit risk; c. a procedure of aggregation, which includes the results of the risk quantification and evaluation of scenarios taking into account the effect of diversification.
The DFI can define how the reinsurance contracts are taken into account in the model.
Art. 12 frequency and time of calculating the insurer calculates the available reserves and the minimum level of reserves at the beginning of each calendar year.
If the risk situation changes significantly during the year, it determines approximately the amount of the reserves available and the minimum level of reserves at more frequent intervals and communicates the results to the supervisory authority.
It attached to its application for approval of premiums an estimate of the reserves available at the end of the current year and the minimum level of reserves for the following calendar year. The estimate includes several assumptions. For each assumption, the insurer says the probability of occurrence taking into account his individual risk of change in membership.
Art. 13 report the insurer shall annually report on the calculation of the available reserves, and on the minimum level of reserves.
The report must contain all of the critical information to understand the calculation of the available reserves, the calculation of the minimum level of reserves and the situation of the insurer's risk.
It is signed by the direction and handed over to the supervisory authority. The DFI fixed the date of delivery of the report.
Section 2 Provisions techniques art. 14. the insurer is its technical provisions according to recognized actuarial methods. It is without taking into account the rights arising from reinsurance contracts it has entered into.
He dissolved the technical provisions have become unnecessary.
He indicates in his operating plan conditions of constitution and dissolution of the technical provisions. It documents the assumptions underpinning his choices, in particular the calculation bases and methods of creation of provisions.
The DFI can define the principles for the constitution and the dissolution of provisions.
Section 3 tied assets art. 15 date of calculation of the flow the insurer calculates the flow rate at the date of closing of the accounts.
On motivated request of the insurer, the supervisory authority can allow the calculation of the flow at a later date.
When the circumstances warrant, it may require a new calculation or an estimate of the flow rate.
Art. 16 disclosure obligation the insurer shall communicate to the supervisory authority no later than March 31 rate calculated for the end of the financial year, with inventory coverage values.
Art. 17 cover flow must be covered at all times by assets.
If it finds an overdraft, the insurer informs the supervisory authority and complete fortune without delay. If in special circumstances, the supervisory authority may grant a period to complete the tied assets.
The property covered by the tied assets must be free of any commitment. The commitments of the insurer may be offset by receivables owned by the tied assets. Art. 19, al. 1, let. f, is reserved.
Art. 18 constitution the insurer is tied assets by assigning property. It records and distinguishes the goods assigned to the tied assets so as to be able to prove at any time and without delay what assets belong to the tied assets and flow of tied assets is covered.
He chose the property belonging to the tied assets in the first place based on their security and the actual financial situation.
It tends to a performance in line with the market in application of the proper principles of diversification and ensures that the foreseeable need for liquidity is assured at all times.
The supervisory authority may, at the request of the insurer, authorize the taking into account, in whole or in part, claims arising from reinsurance contracts for the constitution of tied assets, provided that the reinsurer guarantees these loans with its tied assets.
Insurers who offer social insurance and insurance within the meaning of the LCA must distinguish the tied assets of social insurance as such.
SR 221.229.1 art. 19 consistent investments the following investments are deemed compliant: a. cash, bank accounts, term deposits and investments money market with a maturity of 12 months maximum; b. debt, denominated in the amount fixed, other than those referred to in the let. has, including bonds, option bonds, convertible bonds and the mortgage; c. the shares, participation certificates, the right of enjoyment, cooperative shares and other participation in the capital, for as much as they are listed or dealt on another regulated market open to the public and they can be sold in the short term; d investments in residential or commercial buildings. property or condominium unit, including in administrative premises for his own use; (e) the collective investment schemes within the meaning of art. 8, 9, and 119, al. 1, of the Federal law of 23 June 2006 on the collective investment schemes which meet the following conditions: 1. be approved and authorized for distribution in Switzerland by the federal supervisory authority of financial markets, 2. contain only the investments referred to in the let. a to d, 3. be organized in terms of guidelines, allocation of skills, determination of shares as well as sale and purchase of these shares so as to safeguard the interests of the participating insurers clearly;
(f) the financial derivative instruments which fulfil the following conditions: 1. serve only to cover fortune, 2 do not exert leverage on the fortune, 3 rest on underlying that conform to the meaning of the let. a to d, which are an integral part of fortune and whose value trust takes into account variations guaranteed market, 4. be covered for all commitments arising for the insurer or which may result in the worst case of the exercise of the right during the conversion into underlying.
Other investments, including investments in institutions who are used to the practice of social insurance (art. 46, para. 1, let. b), are deemed non-compliant.
If the insurer cannot prove that the investments of the tied assets cover all claims under the reports of insurance and reinsurance contracts it has entered into, particularly because some investments are not consistent, the supervisory authority can a deadline to complete or change investment.
SR 951.31 art. 20 limits the investment of tied assets are deemed non-compliant if they exceed the limit below, unless they are covered effectively by financial derivatives in the sense of art. 19, al. 1, let. f: a. all investments: 5% of fortune linked by debtor; for the investments referred to in art. 19, al. 1, let. a, 20% of the tied assets by debtor when it is a bank within the meaning of the law of 8 November 1934 on banks; (b) investments referred to in art. 19, al. 1, let. c: 25% of fortune linked; c. investments referred to in art. 19, al. 1, let. d: 25% of tied assets and: 1 5% at the maximum of the tied assets abroad, 2 5 maximum per cent of fortune linked by subject, unless the insurer cannot be used for its own use;
d. foreign currency investments: 20% of the tied assets.
The claims against the Confederation, the cantons and the Swiss institutions issuing letters of guarantee are not subject to the deadline of the al. 1, let. a. the DFI may issue guidelines on the calculation of the limits.
RS 952.0 art. 21 limits in the case of collective investment schemes investments and foreign currency included in the collective investment schemes are taken into account in the calculation of investment limits. When a collective investment scheme is composed of various types of investments referred to in art. 19, al. 1, let. a to d, or of different currencies, it is proportionally between categories of investments or currencies as long as the shares are verifiable. If the shares are not verifiable, it is entirely attributed to the type of investment subject to the most severe limits.
The collective investment schemes are considered non-compliant if they exceed 5% of the assets bound by investment, unless they meet the following conditions: a. their diversification can be verified properly; b. values of fortune can be withdrawn in favour of the investor in case of bankruptcy of the collective investment scheme or his bank deposit.
Art. 22 conservation of property the insurer must entrust its securities assigned to tied assets to a custodian.
It communicates to the supervisory authority the depositary and the place of deposit as well as any changes in these indications.
The custodian holds an inventory of values and refers to it as belonging to the tied assets.
The conservation contract must provide that the depositary responds to the insurer of the performance of the obligations of guard.
If important reasons so justify, the supervisory authority may at any time order a change of custodian or place of filing.
Art. 23 verification by the supervisory authority supervisory authority checks at least once a year: a. If the flow rate is calculated correctly; b. If goods assigned to the tied assets: 1, 2 are assigned and stored in accordance with the regulations, 3 correspond at least to the flow of tied assets, 4 please the prescriptions of placement of the surveillance law.
It can limit the audit surveys.
It can take into account the results of an audit made by the organs of the insurer or by the organ of external review and inventory by the depositary.
Art. 24 the use of tied assets product of tied assets is used first to cover receivables arising from insurance and reinsurance contracts guaranteed under art reports. 15 LSAMal. Any balance is used to cover the administrative costs related to the granting of these receivables.
Section 4 compulsory insurance of care art. 25 premiums when it checks the rates of premiums, supervisory control authority that the revenue estimated the insurer cover its spending estimates for the fiscal year.
Costs within the meaning of art. 16, al. 3, LSAMal include all costs of the insurer in the canton in question, after deduction of a share of its capital.
Premiums of policyholders who reside in a Member State of the European Union, Iceland or Norway must cover costs for policyholders of all these States for the insurer, after deduction of a share of its capital. To set premiums for holders of these States, the insurer takes into account the cost differences between the States.
To determine the share referred to in paras. 2 and 3, the insurer cannot use its capital income that does not exceed the average of the capital gains it has made in the last ten years. The share is set according to the estimate of receipts from premiums in the canton or the State concerned.
The reserves are excessive in the sense of art. 16, al. 4, let. d, LSAMal when the minimum level of insurance reserves coverage would be guaranteed long term with a lower level of reserves. For judging, the supervisory authority is based on the operating plan and the indications referred to in art. 12, al. 3 art. 26 voluntary reduction of excessive reserves the insurer may reduce its reserves if they are likely to become excessive.
The reduction takes place over one or more years. The insurer establishes a plan for this purpose. The supervisory authority verifies each year that the conditions to reduce the reserves are there.
Reserves to offset in the form of a compensation to policyholders. The amount shall be divided between the insureds in the territorial scope of activity of the insurer according to a key to equitable distribution set by the insurer.
The insurer is the amount of the compensation in deduction of the bonus approved by the supervisory authority and stated separately on the invoice for the premium.
Art. 27 approval of premium rates
The insurer shall submit to the approval of the supervisory authority compulsory care insurance premium rates and their changes no later than five months before their application.
The supervisory authority sets in a directive documents and information that must be attached to the rates and according to what standards they are transmitted.
It sets a deadline for the cantons to give their opinions in the sense of art. 16, al. 6, LSAMal; It takes into account in this regard the deadlines prescribed in art. 7, al. 2, of the Federal Act of 18 March 1994 on health insurance (KVG).
She approves the rates of premiums for a calendar year. If, on the basis of the documents that were provided, she doubts the compliance of premiums with the requirements of art. 16 LSAMal, it can approve a tariff of premiums for less. The insurer communicates this duration to policyholders as part of the new premium.
RS 832.10 art. 28 publication of premiums if the insurer publishes the approved premium rate, it must publish premiums for all insurance forms that he practices.
Section 5 optional individual insurance of daily allowances art. 29. the art. 25, 26, 27, al. 1, 2 and 4, and 28 apply by analogy to the premiums for optional insurance of daily allowances.
Section 6 Compensation premiums received in art too. 30 cumulative costs the cumulative costs of an insurer are all its costs over a year.
Art. 31 assessment of the economic situation of the insurer the insurer is in an economic situation that allows compensation of premiums received in too if, after him have done, it has reserves greater than 150% of the minimum level referred to in art. 11, al. 1 art. 32 procedure the supervisory authority sets in a directive the documents and information that the insurer shall attach to the request for approval within the meaning of art. 17 LSAMal.
It shall communicate its decision to the cantons concerned.
Art. 33 the repayment terms the amount of compensation approved by the supervisory authority shall be divided between the insured according to a key to equitable distribution set by the insurer.
The insurer shall provide the insured the amount of the rebate to the senses of the art. 18 LSAMal.
It brings the amount of the rebate in deduction of premiums due and does appear separately on the invoice. It can also pay separately to the insured.
It can compensate for it with premiums or contributions to costs owed to him.
Section 7 fees of Directors art. 34 distribution of administrative costs associated with Medicare administrative costs are divided between the following insurance, based on their actual expenses: a. the mandatory healthcare insurance; b. daily allowance insurance; c. supplementary insurance and other insurance lines.
Art. 35 intermediary activity and advertising expenses is an intermediary within the meaning of art activity. 19 LSAMal any activity by which a person puts his skills or services available to the insurer against remuneration in order to facilitate or allow the affiliation of policyholders.
Including part of advertising expenses all expenses related to exploration of insured persons, regardless of the channel and the means used.
If insurers conclude an agreement in the sense of art. 19, al. 3, LSAMal, they shall communicate it to the supervisory authority.
Chapter 4 management and review Section 1 risk management and internal control system art. 36 composition of the governing body, the governing body is composed so as to be able to assume the tasks monitoring and senior management of the insurer in an impeccable way. In particular, it must have sufficient knowledge of insurance.
Each Member of the administrative body must have the technical knowledge necessary to carry out its task.
Art. 37 composition of the Executive management body is composed so as to be able to perform its tasks.
The members of the management body must have the knowledge necessary to the conduct of the sectors that are subordinate to them.
Art. 38 publication of links of interest to anyone who comes into position within the Board of directors or the management body shall indicate the following in writing to the supervisory authority: a. the position it has held bodies of direction, monitoring, Council or other, in companies, institutions or foundations Swiss or foreign, private law or law public; b. it functions within public communities; c. the Permanent Executive functions or the Board exercised on behalf of Swiss or foreign interest groups.
Art. 39 prevention of conflict of interest the insurer issues internal directives to prevent conflicts of interest. He gives a copy to the supervisory authority.
Art. 40 objective and content the management of risk and the internal control system by a risk management appropriate to its business and internal control mechanisms, the insurer guarantees that: a. the potential risks are identified and assessed in time; ETB. the necessary measures to prevent or to cover significant risks and the accumulation of risks are taken in time.
Management risks features including: a. the determination and regular review, by the bodies of the insurer, of strategies and measures on all of the risks involved; b. a policy taking account of the effects of the strategy of the insurer and coverage including an adequate reserve staffing; c. adequate procedures ensuring that the monitoring of all risks is integrated in the Organization of the insurer; d. identification , monitoring, quantification, and the all important; e. risk management analysis of the impact of different scenarios of crucial risk and the development of contingency plans correspondents; (f) an internal reporting system to identify, assess and control risks and risk concentrations, as well as the processes associated with them.
Internal control mechanisms include functions and processes to ensure that, overall, the legal requirements and internal guidelines.
Risk management and internal control mechanisms should be in line with the size of the insurer, the complexity of its business and its organization and the risks that he runs.
Art. 41 documentation related to risk management and internal control system the insurer described its risk management and internal control system in documentation. He regularly maintains her.
This documentation covers including the following: a. the description of the organisation of the management risks and the internal control system at the level of the insurer as a whole and the powers and corresponding responsibilities; b. management of risk and the control system requirements internal; c. policy risks, including risk tolerance; (d) the procedure for the identification of significant risks and methods tools and processes to measure, monitor and control; e. the presentation of the control system internal as well as systems of limits for exposures to risk; f. internal guidelines for the risk management, internal control system and the processes associated with them.
Art. 42 internal auditors the internal auditors is submitted directly to the governing body. The latter appoints the Chief. The internal auditors receive any guidance from the executive body. It has free access to information and documents inside the company insofar as he needs to complete his task.
If the tasks of the internal auditors are delegated to a third party, para. 1 apply by analogy to the latter. The internal control system cannot be delegated to the external auditor of the insurer.
Section 2 risk management concerning the fortune article 43 investment principles the insurer must place, manage and control his fortune with care.
All goods with the exception of insurance governed by the ACL values are considered as fortune.
The insurer ensures the security and sustainability of the investments, guarantees the necessary liquidity and spreads the risk appropriately between different categories of investments, different regions, different economic sectors and different debtors.
Defines an investment strategy tailored to its ability to risk, reconsidered periodically and adapted it as needed.
He is trying to achieve an appropriate return compared to the conditions offered by the monetary, financial and real estate markets.
He has knowledge about its investment strategy and apply the procedures needed to assess at any time the risk of its investments.
It ensures that investments are simple to assess the creditworthiness of the debtors to be good and controllable.
SR 221.229.1 art. 44 requirements asset management
The insurer cannot entrust the placement and management of his fortune to people or institutions whose skills and organization to ensure compliance with the requirements of this order and the LSAMal.
He made sure his asset management and control are made by different people.
He concluded in writing any investment or asset management mandates entrusted to third parties.
It retains the fortune in Switzerland.
Art. 45 investment regulations the insurer shall draw up regulations for investment.
The investment regulations must: a. set the strategy, objectives, principles, organization and processes governing the management of fortune; b. address control of asset management; c. contain rules to avoid conflicts of interest, including prescriptions on the legality of delivery of bank commissions and on the legality of the business for its own account; d. set the obligation for persons responsible for placing the fortune to report their interests; e. set one minimum solvency of debtors.
The investment regulations and its amendments must be sent to the regulator for for information.
Art. 46 weighting of investment risk the following investments are not considered as risky: a. the investments referred to in art. 19; (b) investments in institutions who are used to the practice of social insurance.
All other investments and mortgage loans are considered risky.
The investments referred to in para. 1, let. b, which represent more than 2% of the assets are considered to be risky and should be communicated to the supervisory authority. The DFI can define what investments are considered as investments within the meaning of para. 1, let. b. art. 47 risk management regarding financial derivatives when investments in financial derivatives in the sense of art. 19, al. 1, let. f, the insurer takes into account their marketability and creditworthiness of the counterparty.
He gives each year to the supervisory authority a report on the transactions involving derivative financial instruments.
Art. 48 exclusion of the loan of securities and operations of setting or repurchase the securities lending and repo or setting operations are not allowed.
The loan of securities within a collective investment scheme within the meaning of art. 19, al. 1, let. e, is allowed when the right to demand the return of borrowed values is guaranteed in an effective manner.
DFI may issue more detailed provisions.
Section 3 Presentation of accounts and Auditors art. 49 principles the insurer holds a separate accounting for social insurance.
The federal Office of public health (FOPH) can set requirements on the preparation of the accounts.
Art. 50 management report management report must be established in accordance with the provisions of the Foundation for recommendations related to the presentation of the accounts in their version of December 10, 2014 (CPP provisions). It consists of the annual report and the annual accounts (balance sheet, account results, table of cash flows, statement of the capital own and annex).
The FOPH may set additional requirements. If it fixes, the insurer decides whether applying the provisions of the CPP or CPP provisions supplemented by special requirements.
The main data by branch of insurance within the meaning of art. 1A, al. 1, KVG and figures referred to in art. 28b OAMal should be mentioned in the management report.
The insurer must publish the annual report no later than June 30 of the year following the end of the year.
The recommendations can be obtained against payment with the SKV Editions, Hans-Huber-Strasse 4, 8002 Zürich (www.verlagskv.ch).
RS 832.10 SR 832.102 art. 51 annual accounts of the FOPH surveillance law sets specific requirements for the annual accounts of the surveillance law.
The annual accounts of the surveillance law are established according to the CPP provisions supplemented by the specific requirements referred to in para. 1. the insurer must provide annual accounts under law of surveillance to the supervisory authority at the latest on 31 March of the year following the end of the year.
The recommendations can be obtained against payment with the SKV Editions, Hans-Huber-Strasse 4, 8002 Zürich (www.verlagskv.ch).
Art. 52 review body outside the provisions of the code of obligations related to the Auditors of public companies apply when neither the LSAMal, nor the present order or the instructions of the supervisory authority contain special requirements for insurers.
The responsibility of the external auditors is governed by the law of the Corporation.
The supervisory authority appoints the external auditors if the insurer has not appointed him after summation.
When an insurer appoints a new external auditors, it shall inform the supervisory authority.
RS 220 art. 53 tasks and competencies of the external auditors the external auditors control the annual accounts of the surveillance law, the statutory annual accounts and the tied assets according to the principles of the ordinary review.
The supervisory authority charge the external auditors to control each year that the system of internal control is effective and adapted to the size and complexity of the company.
The external auditors may conduct on-site intermediate revisions, especially in case of doubt about the keeping of the accounts and management.
Art. 54 reports of the external auditors the External Auditors reports annually the following: a. a report on the annual accounts in accordance with the provisions of the Foundation for recommendations related to the presentation of accounts; b. a detailed report to the governing body, established in accordance with the provisions of the code of obligations and the requirements of the supervisory authority; c. a report on the annual accounts under the surveillance law established in accordance with the instructions of the supervisory authority.
He reports to the supervisory authority and the internal auditors.
The recommendations can be obtained against payment with the SKV Editions, Hans-Huber-Strasse 4, 8002 Zürich (www.verlagskv.ch).
RS 220 Chapter 5 reinsurance art. 55 minimum number of policyholders only health insurance providing at least 300,000 people can obtain an authorization to practice the reinsurance within the meaning of art. 28 LSAMal.
Art. 56 application for leave application for leave must be submitted to the supervisory authority no later than 30 June of the year preceding the year where the insurer intends to practice the reinsurance for the first time.
Art. 57 beginning of the validity of the authorization the authorization to practice the reinsurance takes effect at the beginning of a calendar year.
Art. 58 withdrawal of the authorization, the supervisory authority can withdraw the permit to practice reinsurance to an HMO if it provides less than 300,000 people for more than a year.
If the reinsurer is unable to demonstrate that it has reinsured insurers according to the LSAMal during the previous two years, the reinsurance business is deemed completed. The supervisory authority withdraws its authorization to practice the reinsurance.
Art. 59 reinsurance contracts the insurer may only enter into contracts of reinsurance on the same terms as those that should be with a third independent.
He can commit to pay the reinsurance premiums of 50% of the total of the premiums paid by policyholders.
He must present to the supervisory authority the reinsurance contract or its amendments for approval no later than one month before their validity. He joined the profit and loss accounts for the duration of the contract.
It regulates the terms of termination in the reinsurance contracts. They need to be terminated at the end of each calendar year. The period of notice must be at least six months.
The supervisory authority may ask the insurer and reinsurer of data to assess whether the provisions of para. 1 are met.
Art. 60 obligations of the reinsurer the reinsurer must constitute technical provisions according to actuarial methods recognised.
At the request of the supervisory authority, must make available the main actuarial information relating to reinsurance contracts past and present.
Chapter 6 Surveillance art. 61 equal treatment of insured persons and protection against abuse the insurer treats all holders equally, regardless of their State of health or an indication in this regard, especially for admission in insurance, the choice of the form of insurance, communications to the insureds and the period of repayment of benefits.
Constitute abuse within the meaning of art. 34, al. 1, let. e, LSAMal: a. repeated damage to an insured person; (b) damage to an insured person by a significant inequality of treatment and legally or actuarially unjustifiable; c. the systematic damage to a group of insureds.
Art. 62 coordination between supervisory authorities
The supervisory authority and the federal financial market supervisory authority coordinate their monitoring activities when the practice of the social health insurance has or may have an influence on insurance within the meaning of art. 2, al. 2, LSAMal. Have such an influence including: a. lower reserves at least provided in art. 11; b. provisions below the level set in art. 14; c. a violation of the provisions on tied assets; (d) the transfer of a number of insureds to the senses of the art. 9, al. 3, and 40 LSAMal; (e) a change in the legal structure of the insurer, a transfer of assets or a participation within the meaning of art. 9 and 10 LSAMal; (f) any criminal offence having or that may have an influence on the practice of insurance within the meaning of art. 2, al. 2, LSAMal; (g) a violation of the provisions on the guarantee of irreproachable activity on risk management and review; h. a compromised financial situation; i. provisional measures within the meaning of art. 38 LSAMal; j. a violation of the provisions of the right of supervision.
The supervisory authority and the federal supervisory authority of financial markets can also coordinate their monitoring activities through regular exchanges of information on entities subject to their supervision.
Art. 63 announcement of facts of great importance are of great importance within the meaning of art. 35, al. 3, LSAMal the following in particular: a. the conditions referred to in art. 5 LSAMal are no longer met; (b) reserves are below the minimum level provided in art. 11 or provisions are below the needs within the meaning of art. 14; c. any offence likely to have considerable influence on the insurer.
Art. 64 compromised the financial situation of an insurer is compromised in the sense of art. 38, al. 3, LSAMal when every reason to believe that the insurer is unable to meet legal requirements for more than two years without taking any action provided for in art. 38, al. 2, let. g and h, LSAMal.
To determine if the financial situation of an insurer is compromised, the supervisory authority examines in particular: a. If the insurer recorded a significant financial loss; b. If delays in the valuation of the investments do not allow a sufficient liquidity; c. If the insurer recorded a massive influx of new policyholders; d. If the structure of the number of policyholders has deteriorated.
Art. 65 transfer of membership of the insured the supervisory authority may take all necessary measures to ensure the transfer of the number of policy holders of one insurer to another.
When choosing the insurer called to resume all or part of the population of the insured to another insurer, the supervisory authority ensures that the new insurer bear the financial and institutional recovery. She is not required to take into account the competitive position of insurers.
Art. 66 transactions between the insurer and other companies if the supervisory authority check a transaction referred to in art. 44, al. 1, LSAMal, it controls that it complies with the conditions of the market. The conditions are deemed consistent with the market if the transaction would have been concluded on the same terms with a third independent.
Chapter 7 Institution common art. 67 business management and external auditors art. 36 to 39 and 52 to 54 apply by analogy to the common institution.
Art. 68 of the Insolvency Fund Board of Trustees of the fixed common institution the amount of insolvency in function Fund risks that the Fund must fully cover. The supervisory authority is requested to give its opinion until a decision is made.
Art. 69 investment of resources from the insolvency fund the placement of resources is governed by the investment regulations enacted by the Board of Trustees of the institution.
The return on capital returns to the Insolvency Fund.
Changes of the investment regulations must be submitted beforehand to the supervisory authority.
Chapter 8 supervisory authority art. 70 monitoring the common institution of the supervisory authority examines the financial condition of the common institution and ensure that it executes the tasks assigned to him in accordance with the law.
The art. 34 and 35, al. 3, LSAMal apply by analogy to the common institution.
Art. 71 the supervisory authority public information puts the following information available to the public: a. a list of insurers who are admitted to practice the social health insurance, with an indication of their legal form, their headquarters, their territorial scope of activity, of their workforce to policyholders and the insurance group which they are part; (b) a list of reinsurers who are admitted to practice reinsurance in social health insurance with reference to their legal status, their headquarters and the insurance group which they are part; c. premiums rates it has approved and the duration for which it has approved; (d) in the case of premiums received in too, the amount of compensation that has been approved within the meaning of art. 17 LSAMal.
Chapter 9 provisions final art. 72 other acts changing the amendment of other acts is set in the annex.
Art. 73 transitional provisions the supervisory authority withdraws the insurer which has no insured during the two years following the entry into force of this order permission to practice the social health insurance. She releases it monitoring.
The documentation referred to in art. 41 is provided for the first time to the supervisory authority at the latest two months before the deadline referred to in art. 59, al. 1, LSAMal.
The information referred to in art. 38 are reported for the first time to the supervisory authority at the latest two months prior to the period referred to in art. 59, al. 2, LSAMal.
The insurer shall ensure that its reserves have reached the minimum level referred to in art. 11 one year after the entry into force of this order.
Before the date referred to in para. 4, insurers which reserves do not reach the minimum level must meet the following conditions: a. dispose of the reserves of security referred to in art. 78, al. 4, OAMal in his version of April 26, 2006; (b) have a reinsurance if they provide less than 50,000 people in the mandatory healthcare insurance.
The insurer shall make the investment regulations of the supervisory authority in the two years following the entry into force of this order.
He places his fortune in accordance with art. 43 to 48 by the end of the second year following the entry into force of this order.
The supervisory authority shall inform the investments referred to in art. 46, al. 1, let. b, which exist at the entry into force of this order, within two years following the entry into force of this order.
RS 832.102 RO 2006 1717 art. 74 coming into force this order comes into force on January 1, 2016.
Annex (article 72) change other acts the following orders are changed as follows:...
Mod. can be found at the RO 2015 5165.
Status January 1, 2016