Rs 832.112.4 Order Of November 7, 2007 On Federal Subsidies For The Premium Reduction In Insurance (Orpm)

Original Language Title: RS 832.112.4 Ordonnance du 7 novembre 2007 sur les subsides fédéraux destinés à la réduction des primes dans l’assurance maladie (ORPM)

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832.112.4 order on federal subsidies for the reduction in premiums in health insurance (ORPM) November 7, 2007 (Status January 1, 2016) the Swiss federal Council, view the art. 66 and 96 of the Federal Act of 18 March 1994 on health insurance (KVG), stop: art. 1 purpose this rule order: a. the calculation of subsidies from the Confederation to the reduction in premiums, according to art. KVG 66; b. the distribution of these grants between the cantons.

Art. 2 gross gross costs according to art. 66, al. 2, KVG are calculated on the basis of the following indicators: a. prime average (PM); b. effective holders (EA); c. effective insurance estimate (EAest) d. premiums receivable (PR); e. participation in costs (PC).

The average premium (PM) is the award-winning monthly average for adults, from 26, affiliated with care with a standard deductible insurance and accident coverage. The federal Office of health public (FOPH) computed, according to cantons and regions of premiums, based on premiums that are approved for the number of insured persons domiciled in Switzerland.
The number of policy holders (EA) corresponds to the average strength during the year. Part of: a. the insured domiciled or residing in Switzerland, etb. the insured domiciled or staying abroad according to the art. 4 and 5 of the Ordinance of 27 June 1995 on Medicare.

Obliged to ensure, persons domiciled in a Member State of the European Community or of the European Free Trade Association, are not included in membership referred to in para. 3. the number of insured persons is estimated (EAest) for year x extrapolated over two years the most recent actual known with the rate of development of the past two years, according to the following formula: premiums receivable (PR) correspond to the sum of premiums according to the premiums rates approved for membership of the insured.
Participation in costs (PC) corresponds to the sum of the costs borne by the number of insured persons.
To calculate the number of insured, premiums to receive and the cost-sharing, the FOPH is based on data reported by insurers.
The FOPH calculates the gross costs (CB) for a calendar year (x) on the basis of the following formula: year × - 4 year × - 3 year × - 2 SR 832.102 art. 3 distribution between the cantons the share of each canton to federal subsidies is based on the following indicators: a. resident population of the canton (PopC); b. resident population in Switzerland (PopCH); c. number of frontier workers and members of their families, referred to in art. 65a, let. has, of LAMal and domiciled in the canton (FrC); d. number of frontier workers and members of their families, referred to in art. 65a, let. has, of LAMal and domiciled in Switzerland (FrCH).

The calculation of the resident population of the cantons is based on figures from the last statement of the average resident population carried out by the federal Office of statistics.
The calculation of the number of border insured workers and members of their families is based on the figures resulting from the last survey of the FOPH of insurers.
The FOPH calculates the share coming to each canton (Pcant) on the basis of the following formula: in case of compensation for premiums received in too in the sense of art. 17 of the Act of 26 September 2014 on health surveillance, it deducts a 7.5% share which amounts to each canton within the meaning of para. 4. the federal Department of the Interior can define how the deduction is calculated.
He publishes, annually in October, the distribution of federal subsidies between the cantons for the following year.

RS 832.12 introduced by section 5 of the annex to the O from 18 nov. 2015 on the supervision of insurance, in effect since Jan. 1. 2016 (2015 5165 RO).

Art. 4 payment federal subsidies are paid in three instalments in the current year.

Art. 5 count of the cantons on federal and cantonal subsidies count covers the calendar year. The cantons must submit their statement to the OFSP at the latest on 30 June of the following year.
After hearing of the cantons, the FOPH establishes a form which contains information on the number, sex, age, income and the composition of households of the beneficiaries for the count.
The cantons which entrust to the Commons set and care to pay the subsidies for the reduction in premiums control Commons accounts and set a summary for the FOPH, in accordance with the directions of the.

Art. 6 control the cantons joined the countdown a report that provides information on the date and scope of the business review, the findings to the outcome of the review and the conclusions to be drawn.
The SFOPH ensures, within the meaning of art. 25 of the Act of 5 October 1990 on subsidies (LSu), federal subsidies are used in accordance with the law.

RS 616.1 art. 7 return, reduction and postponement of payments of subsidies paid subsidies wrongly must be returned in accordance with the art. 28 and 30 LSU.
If a count is incomplete or has inaccuracies, or if the provisions of the new Act, this order or instructions y related have not been met, the restitution of part of the subsidies may be required or these can be reduced according to art. 28, al. 2, LSu until that situation is regularized.

RS 616.1 art. 8 jurisdiction when insureds transfer their homes from one canton to another, the right to the premium reductions exist for the duration of the calendar year under the law of the canton in which the insured had their home on January 1. This canton operates the premium reduction.
The al. 1 apply by analogy to the insured mentioned in art. 65a, let. a and b, LAMal, which the anchor with a given canton is transferred to another canton.

Art. 9 repeal and amendment of current law the order of 12 April 1995 on federal subsidies for the reduction in premiums in Medicare is repealed.

[RO 1995 1377, 2006 1945 1996 1978, 2001 141 2314, 2002-927-3913 Appendix 3 c. 13].
The mod. can be found at the RO 2007 6071.

Art. 10 transitional provisions the cantons that were required during the year before the entry into force of this order, the maximum of federal subsidies, may carry over to the following year differences between subsidies requested according to art. 5 of the order of 12 April 1995 on federal subsidies for the reduction in premiums in Medicare (old ORPM) and the subsidies actually paid.
Only the amount differences due to discrepancies between the subsidies requested and those actually paid may be carried forward. These differences can amount up to 10% of the requested federal subsidies. The deferred amounts that have not been used within one year of the entry into force of this order must be returned.
The first year following the entry into force of this order, federal subsidies remaining from the previous year according to art. 6, let. b, the old ORPM, are paid to no later than three months after receipt of the final count. A possible difference of amount according to the al. 1 and 2 is paid at the same time.

[RO 1995 1377, 1996 1978; 2001 141 2314, 2002 927 3913, 2006 1945 Appendix 3 c. 13].

Art. 11 entry into force this order comes into force on January 1, 2008.

RO 2007 6071 RS 832.10 State on January 1, 2016