Key Benefits:
27 June 1995 (State 1 Er January 2016)
The Swiss Federal Council,
See art. 81 of the Federal Act of 6 October 2000 on the General Part of Social Insurance (LPGA) 1 , given art. 96 of the Federal Health Insurance Act of 18 March 1994 (loi/LAMal) 2 , given art. 82, para. 2, of the Therapeutic Products Act of 15 December 2000 (LPTh) 3 , 4
Stops:
1 Persons domiciled in Switzerland as defined in Art. 23-26 of the Swiss Civil Code (CC) 1 Are required to ensure, in accordance with s. 3 of the Act.
2 The following are also required to ensure:
1 RS 210
2 New content according to the c. I 4 of the O of 24 Oct. 2007, effective from 1 Er Jan 2008 ( RO 2007 5627 ).
3 RS 142.20
4 New content according to the c. I 4 of the O of 24 Oct. 2007, effective from 1 Er Jan 2008 ( RO 2007 5627 ).
5 New content according to the c. I 4 of the O of 24 Oct. 2007, effective from 1 Er Jan 2008 ( RO 2007 5627 ).
6 RS 142.31
7 Introduced by c. I of the O of 3 Jul. 2001 ( RO 2002 915 ). New content according to the c. I of the O of 2 nov. 2011, in force since 1 Er Apr 2012 (RO 2012 955).
8 RS 0.142.112.681
9 Introduced by c. I of the O of 3 Jul. 2001 ( RO 2002 915 ). New content according to the c. I of the O of 22 May 2002, in force since 1 Er June 2002 (RO 2002 1633).
10 RS 0.632.31
11 Introduced by c. I of the O of 22 May 2002, in force since 1 Er June 2002 ( RO 2002 1633 ).
12 Introduced by c. I of the O of 3 Dec. 2004, in effect since 1 Er Jan 2005 ( RO 2004 5075 ).
1 The following are excepted from the obligation to:
2 Exceptions shall be made to persons who are compulsorily insured against the disease under the law of a State with which there is no regulation on the delimitation of the obligation to ensure, to the extent that it is subject to liability Swiss insurance would mean a double burden and as long as they have equivalent insurance coverage for treatment in Switzerland. The request must be accompanied by a written attestation from the competent foreign agency providing all the necessary information. 10
4 The following are excepted at the request of persons staying in Switzerland as part of a training or development, such as students, schoolchildren and trainees, as well as members of their families within the meaning of art. 3, para. 2, which accompany them, provided that, for the duration of the validity of the exception, they receive equivalent insurance coverage for treatment in Switzerland. 12 The request must be accompanied by a written attestation from the competent foreign agency providing all the necessary information. The competent cantonal authority may exempt these persons from the obligation to ensure for up to three years. On request, the exception may be extended for another three years at most. The person concerned cannot return to the exception or renunciation of an exception without special reasons. 13
5 On request, workers posted to Switzerland who are exempt from the obligation to pay the contributions of Swiss old-age, survivors and invalidity insurance (AVS/AI) under an international social security agreement are excepted As well as family members within the meaning of s. 3, para. 2, where their employer undertakes to ensure that, for the duration of the validity of the exception, at least the benefits provided by the LAMal are insured for the treatment in Switzerland. This provision shall apply mutatis mutandis to other persons exempted from the obligation to pay DAVS/AI contributions by an exceptional authorisation provided for in an international convention in the event of a temporary stay in Switzerland. The person concerned or his employer cannot return to the exception or renunciation of an exception. 15
6 The following are excepted at the request of persons residing in a Member State of the European Union, provided that they may be excepted from the obligation to ensure under the Agreement on the Free Movement of Persons and its Annex II and They prove that they benefit in the State of residence and during a stay in another Member State of the European Union and in Switzerland of a cover in the event of sickness. 16
7 Exceptions shall be made on request to persons who have a residence permit for persons without gainful employment in accordance with the Agreement on the Free Movement of Persons and the EFTA Agreement, provided that, for the duration of the Validity of the exception, they have equivalent insurance coverage for treatment in Switzerland. The request must be accompanied by a written attestation from the competent foreign agency providing all the necessary information. The person concerned cannot return to the exception or renunciation of an exception without special reasons. 17
8 Excepted on request, persons whose membership of Swiss insurance would result in a marked deterioration in insurance coverage or cover of costs and who, by reason of their age and/or health status, could not To conclude supplementary insurance with the same extent or could only do so under conditions that are difficult to accept. The request must be accompanied by a written attestation from the competent foreign agency providing all the necessary information. The person concerned cannot return to the exception or renunciation of an exception without special reasons. 18
1 New content according to the c. I of the O of Sept. 11. 2002, effective from 1 Er Jan 2003 ( RO 2002 3908 ).
2 RS 833.1
3 Introduced by c. I of the O of 22 May 2002, in force since 1 Er June 2002 ( RO 2002 1633 ).
4 RS 0.142.112.681
5 RS 0.632.31
6 Introduced by c. I of the O of 22 May 2002, in force since 1 Er June 2002 ( RO 2002 1633 ).
7 Introduced by c. I of the O of 22 May 2002 ( RO 2002 1633 ). New content according to the c. I of the O of 2 nov. 2011, in force since 1 Er Apr 2012 (RO 2012 955).
8 Introduced by c. I of the O of 22 May 2002 ( RO 2002 1633 ). New content according to the c. I of the O of 6 June 2003, in force since 1 Er Jan 2004 (RO) 2003 3249).
9 Introduced by c. I of the O of 6 June 2003, in force since 1 Er Jan 2004 ( RO 2003 3249 ).
10 New content according to the c. I of the O of 22 May 2002, in force since 1 Er June 2002 ( RO 2002 1633 ).
11 Repealed by c. I of the O of 22 May 2002, with effect 1 Er June 2002 ( RO 2002 1633 ).
12 New content according to the c. I of the O of 6 June 2003, in force since 1 Er Jan 2004 ( RO 2003 3249 ).
13 Introduced by ch. I of the O of 25 Nov 1996 (RO 1996 3139). New content according to the c. I of the O of 3 Jul. 2001, effective from 1 Er June 2002 (RO 2002 915).
14 Introduced by ch. I of the O of 3 Jul. 2001, effective from 1 Er June 2002 ( RO 2002 915 ). Repealed by c. I of the O of 29 Nov 2013, with effect from 1 Er Jan 2014 (RO) 2013 4523). See also disp. And trans. Of this mod. At the end of the text.
15 Introduced by ch. I of the O of 25 Nov 1996, in force since 1 Er Jan 1997 (RO) 1996 3139).
16 Introduced by ch. I of the O of 3 Jul. 2001 ( RO 2002 915 ). New content according to the c. I of the O of 2 nov. 2011, in force since 1 Er Apr 2012 (RO 2012 955).
17 Introduced by ch. I of the O of 3 Jul. 2001 ( RO 2002 915 ). New content according to the c. I of the O of 22 May 2002, in force since 1 Er June 2002 (RO 2002 1633).
18 Introduced by ch. I of the O of 3 Jul. 2001, effective from 1 Er June 2002 ( RO 2002 915 ).
1 Border residents who are not required to insure under s. 1, para. 2, let. D and e, and who engage in a gainful occupation in Switzerland, as well as members of their families, provided that they do not engage in a gainful occupation abroad involving compulsory health insurance, are subject to Swiss insurance on request from them. 1
2 Spouses and children under the age of 18 are considered to be members of the family and those under the age of 25 who attend school or pursue studies or learning.
1 New content according to the c. I of the O of 22 May 2002, in force since 1 Er June 2002 ( RO 2002 1633 ).
1 They were subject to compulsory Swiss insurance for workers posted abroad, as well as members of their families within the meaning of Art. 3, para. 2, which accompany them, when:
2 Members of the family are not subject to compulsory Swiss insurance if they engage in a gainful occupation abroad involving compulsory health insurance.
3 Compulsory insurance is extended for two years. On request, the insurer extends it to a maximum of six years.
4 For persons considered to be seconded within the meaning of an international social security agreement, the extension of insurance corresponds to the period of secondment authorised by that agreement. The same rule applies to other persons who, by virtue of such a convention, are subject to Swiss law during a temporary stay abroad.
1 The following persons and their family members within the meaning of s. 3, para. 2, who accompany them are subject to compulsory insurance:
2 Members of the family are not subject to compulsory Swiss insurance if they engage in a gainful occupation abroad involving compulsory health insurance.
3 On-site staff are not subject to compulsory insurance.
1 Persons who are beneficiaries of privileges, immunities and facilities referred to in s. 2, para. 2, let. A and c, of the Law of 22 June 2007 on the Host State 2 , with the exception of private domestic servants, are not required to ensure. They may apply for Swiss insurance.
2 Private servants of the beneficiaries mentioned in para. 1 are subject to compulsory insurance when they are not insured in the State of the employer or in a third State. The FDFA shall rule on the application of this provision.
3 Persons benefiting from privileges, immunities and facilities which have ceased to function with an intergovernmental organization, an international institution, a secretariat or other body established by an international treaty, An independent commission, an international tribunal, a arbitral tribunal or any other international body within the meaning of s. 2, para. 1, of the Act of 22 June 2007 on the Host State are, at their request, exempted from compulsory insurance if they benefit from a similar insurance cover for treatment in Switzerland with the health insurance system of their former Organization. The request must be accompanied by a written attestation from the competent body of their former organization giving all the necessary information.
1 New content according to the c. 15 of the Appendix to the O of 7 Dec. 2007 on the host State, in force since 1 Er Jan 2008 ( RO 2007 6657 ).
2 RS 192.12
1 Insurers can only claim in the affiliation form the data necessary for admission to compulsory insurance or to the change of insurer.
2 The affiliation form shall not contain any data, indications or references in relation to insurance within the meaning of Art. 12, para. 2, of the law or with the optional insurance of daily allowances within the meaning of s. 67 to 77 of the Act.
3 Insurers can process personal data only to perform the tasks required by law.
1 Introduced by ch. I of the O of 26 Apr. 2006, effective 10 May 2006 ( RO 2006 1717 ). See also disp. End. Of this mod. At the end of the text.
1 Foreign nationals who are authorised to establish or have a short-term residence permit or a residence permit within the meaning of Art. 1, para. 2, let. A and f, shall be obliged to ensure within three months of their announcement to the competent service for the control of the inhabitants. If they insure themselves on time, the insurance will have effect as from the date of the announcement of the stay. If they later ensure that they are insured, the insurance will have effect as soon as they are affiliated. 2
2 Foreign nationals who hold short-term authorization within the meaning of s. 1, para. 2, let. B, must be insured upon entry into Switzerland. 3
2bis Persons without leave to stay within the meaning of Art. 1, para. 2, let. G, must be insured from the beginning of their lucrative business in Switzerland. When they join later, insurance must also start on the date of the start of their lucrative business in Switzerland. 4
3 For persons referred to in paras. 1 and 2, the insurance shall end on the date of departure announced to the competent service for the control of the inhabitants, in all cases on the day of the effective departure of Switzerland, or on the death of the insured person.
3bis For persons referred to in para. 2 Bis , the insurance expires on the date of the termination of the profit-making activity in Switzerland, but no later than the day of the effective departure of Switzerland, or the death of the insured person. 5
4 Border and family members who intend to be subject to Swiss insurance (art. 3, para. 1) are required to ensure within three months of the commencement of the validity of the border authorization. If they insure in time, the insurance will be effective as of the date of the validity of the authorization. If they later ensure that they are insured, the insurance will have effect as soon as they are affiliated. 6 The insurance ends with the abandonment of the profit-making activity in Switzerland, with the expiry or revocation of the border authorization, the death of the insured person or the renunciation of the liability to Swiss insurance. In the latter case, a new application may not be filed, except in particular.
5 Asylum seekers and persons to be protected shall be obliged to ensure immediately after the assignment to the cantons provided for in Art. 27 LAsi 7 Persons admitted on a provisional basis are required to ensure immediately after the provisional admission decision. The insurance shall have effect upon the filing of the application for asylum, the decision on provisional admission or the granting of provisional protection. It shall end on the day on which it is proved that the insured person has definitively left Switzerland or on the death of the insured person. 8
6 Persons benefiting from privileges, immunities and facilities to be subject to Swiss insurance (art. 6, para. 1) shall ensure within six months from the date on which they have received a DFAE legitimation card. The insurance shall have effect on the date on which they hold the card. The insurance ends with the expiry of the functions in Switzerland, the death of the insured person or the waiver of the liability for Swiss compulsory insurance. In the latter case, a new application may not be filed, except in particular. 9
7 The officers of the current or retired confederation referred to in s. 2, para. 1, let. Out of military insurance must be insured for care within three months after the departure of the military insurance from an insurer designated under s. 11 of the Act. If they insure themselves on time, the insurance is deployed as soon as the military insurance is released.
8 Persons required to ensure under s. 1, para. 2, let. D and e must ensure within three months of the birth of the insurance obligation in Switzerland. If they do so within this period, insurance starts as soon as it is submitted to Swiss insurance. If they do so after that period, the insurance will have effect on the date of affiliation. Insurance terminates when these persons no longer fulfil the conditions of submission to Swiss insurance under the Agreement on the Free Movement of Persons 10 Annex II or the EFTA Agreement 11 , Annex K and Appendix 2 to Annex K. 12
1 New content according to the c. I of the O of 26 Apr. 2006, effective 10 May 2006 ( RO 2006 1717 ).
2 New content according to the c. I of the O of 22 May 2002, in force since 1 Er June 2002 ( RO 2002 1633 ).
3 New content according to the c. I 4 of the O of 24 Oct. 2007, effective from 1 Er Jan 2008 ( RO 2007 5627 ).
4 Introduced by ch. I of the O of 3 Dec. 2004, in effect since 1 Er Jan 2005 ( RO 2004 5075 ).
5 Introduced by ch. I of the O of 3 Dec. 2004, in effect since 1 Er Jan 2005 ( RO 2004 5075 ).
6 New content of the first 3 sentences according to c. I of the O of 3 Jul. 2001, effective from 1 Er June 2002 ( RO 2002 915 ).
7 RS 142.31
8 New content according to the c. I of the O of 27 June 2007, in force since 1 Er Jan 2008 ( RO 2007 3573 ).
9 New content according to the c. 15 of the Appendix to the O of 7 Dec. 2007 on the host State, in force since 1 Er Jan 2008 ( RO 2007 6657 ).
10 RS 0.142.112.681
11 RS 0.632.31
12 Introduced by ch. I of the O of 3 Jul. 2001 ( RO 2002 915 ). New content according to the c. I of the O of 22 May 2002, in force since 1 Er June 2002 (RO 2002 1633).
Insurers may provide persons who are subject to compulsory health care insurance under s. 1, para. 1 and 2, let. A and c, and art. 3 to 6, maintenance of insurance reports on a contractual basis. The contract may be entered into with the same or other insurer. The funding of benefits that correspond to those of compulsory health insurance is governed by the principles of social insurance. The insurance reports are subject to the Federal Act of 2 April 1908 on the insurance contract 2 .
Insurers provide written information to insured persons referred to in s. 6 A , para. 1, of the Act, on the extension of the obligation to ensure.
1 Introduced by ch. I of the O of 3 Jul. 2001, effective from 1 Er June 2002 ( RO 2002 915 ).
1 The premium surcharge provided for in s. 5, para. 2, of the law shall be taken for a period equal to twice the duration of the delay in affiliation, but to a maximum of five years. 1 It is between 30 and 50 % of the premium. The insurer sets the surcharge in accordance with the insured's financial situation. If the payment of the supplement puts it in the discomfort, the insurer fixes a rate of less than 30 %, taking into account fairly the situation of the insured person and the circumstances of the delay.
2 It is not collected as a supplement when premiums are paid by the competent social assistance authority.
3 If the insured changes an insurer, the former insurer must indicate to the new insurer as part of the communication referred to in s. 7, para. 5, of the law, the existence of a premium surcharge. When a first supplement is fixed, subsequent insurers are required to cash it. 2
1 New content according to the c. I of the O of 9 Nov 2005, in force since 1 Er Jan. 2006 ( RO 2005 5639 ).
2 Introduced by ch. I of the O of 9 Nov 2005, in force since 1 Er Jan. 2006 ( RO 2005 5639 ).
Where a prosecution cannot be initiated against an insured person who is not subject to Swiss social assistance legislation or does not result in the payment of premiums or costs, the insurer may terminate the report Of insurance, after a written warning in which he warns the insured of the consequences of his omission.
1 New content according to the c. I of the O of Sept. 11. 2002, effective from 1 Er Jan 2003 ( RO 2002 3908 ).
1 The cantons shall periodically inform the public about the obligation to ensure. In particular, they ensure that persons from abroad, as well as the parents of newborn babies, are informed in good time.
1bis Information on the insurance obligation of holders of short-term residence permits, residence permits and authorisation of establishment also applies equally to family members residing in a State Member of the European Union, Iceland or Norway. 1
2 The competent cantonal authority shall rule on requests under Art. 2, para. 2 to 5, and 6, para. 3. 2
3 The social insurers in charge of the payment of annuities and the bodies of unemployment insurance assist the cantons in their task of providing information on the obligation to ensure to the persons mentioned in art. 6 A , para. 1, let. B and c of the law. 3
1 Introduced by ch. I of the O of 3 Jul. 2001 ( RO 2002 915 ). New content according to the c. I of the O of 2 nov. 2011, in force since 1 Er Apr 2012 (RO 2012 955).
2 New content according to the c. I of the O of 25 Nov 1996, in force since 1 Er Jan 1997 (RO) 1996 3139).
3 Introduced by ch. I of the O of 3 Jul. 2001, effective from 1 Er June 2002 ( RO 2002 915 ).
1 The suspension of the obligation of insurance under s. 3, para. 4, of the law shall have effect on the day on which the insured person is subject to the AML 2 .
2 The insured person is exempt from the payment of premiums at the beginning of his coverage of military insurance if he informs his insurer at least eight weeks in advance. If the insurer does not meet this deadline, the insurer will exempt it from the next possible term, but not later than eight weeks after the announcement.
3 After the entry into service, the competent military authority shall ensure that the insured person announces to his insurer the probable duration of the liability for military insurance and, where applicable, the anticipated end of it.
4 The competent authority for the civil service shall ensure that the insured announces to his insurer any subsequent change in the duration of the liability.
5 If premiums are paid in spite of the suspension, the insurer deducts them on subsequent premiums or refunds.
6 The Federal Office of Public Health (OFSP) may issue instructions to insurers on the calculation of premiums.
7 The insurer announces to the competent cantonal authorities in respect of the reduction of premiums persons whose insurance obligation has been suspended and informs them of the effective duration of the suspension.
1 Introduced by ch. I of the O of 11 Dec. 2000 ( RO 2001 138 ). New content according to the c. I of the O of 26 Apr. 2006, effective from 1 Er May 2006 (RO 2006 1717). See also disp. End. Of this mod. At the end of the text.
2 RS 833.1
1 The suspension of accident coverage under s. 8 of the Act, shall be carried out on the written request of the insured person and shall have effect at the earliest on the first day of the month following that request.
2 Before the end of the working reports, the right to unemployment benefit or the coverage of non-professional accidents, the employer or the unemployment insurance shall inform the insured person in writing that he must indicate to the health insurer the time at which the Accident coverage. The insured person must make this communication to the health insurer within one month of the employer's information or unemployment insurance.
1 Introduced by ch. I of the O of 11 Dec. 2000, in force since 1 Er Jan 2001 ( RO 2001 138 ).
1 Repealed by c. 3 of the annex to the O of 18 Nov 2015 on health insurance surveillance, with effect from 1 Er Jan 2016 ( RO 2015 5165 ).
1 Introduced by ch. I of the O of 3 Jul. 2001 ( RO 2002 915 ). Repealed by c. 3 of the annex to the O of 18 Nov 2015 on health insurance surveillance, with effect from 1 Er Jan 2016 (RO) 2015 5165).
1 Repealed by c. 3 of the annex to the O of 18 Nov 2015 on health insurance surveillance, with effect from 1 Er Jan 2016 ( RO 2015 5165 ).
1 The Joint Institution shall carry out the tasks deriving from Art. 95 A The law as a liaison body. It also carries out tasks as a self-help institution in place of residence, or residence, of insured persons for whom there is a right, based on art. 95 A Of the Act, to international assistance in the field of benefits. It is also responsible for the execution of mutual assistance in the field of benefits and for tasks as a liaison body under other international agreements. 2
2 The Joint Institution shall also carry out the tasks of coordination for the implementation of undertakings deriving from Art. 95 A The law. In particular, it has the following tasks:
3 Costs resulting from the performance of tasks performed by the Joint Institution as a self-help institution and those resulting from the report provided for in para. 2, let. B, are assumed by the insurers, in proportion to the number of persons compulsorily insured with them for the care insurance. The Confederation shall take charge of the interest on the advances of assistance granted in respect of mutual assistance, the costs of the tasks performed by the joint institution as a liaison body and the costs of the calculations referred to in para. 2, let. A. 4
4 Where insurers and benefit providers have agreed in accordance with s. 42, para. 2, of the law that the insurer is the debtor of the remuneration, the common institution is then assimilated, in the case of mutual assistance in the matter of benefits, to an insurer which has concluded that agreement.
1 New content according to the c. I of the O of 3 Jul. 2001, effective from 1 Er June 2002 ( RO 2002 915 ).
2 New content according to the c. I of the O of 6 June 2003, in force since 1 Er Jan 2004 ( RO 2003 3249 ).
3 New content according to the c. I of the O of 2 nov. 2011, in force since 1 Er Apr 2012 ( RO 2012 955 ).
4 New content according to the c. I of the O of 2 nov. 2011, in force since 1 Er Apr 2012 ( RO 2012 955 ).
1 Introduced by ch. I of the O of 28 seven. 1998 ( RO 1998 2634 ). Repealed by c. 3 of the annex to the O of 18 Nov 2015 on health insurance surveillance, with effect from 1 Er Jan 2016 (RO) 2015 5165).
1 Introduced by ch. I of the O of 26 Apr. 2006 ( RO 2006 1717 ). Repealed by c. 3 of the annex to the O of 18 Nov 2015 on health insurance surveillance, with effect from 1 Er Jan 2016 (RO) 2015 5165).
1 Repealed by c. 3 of the annex to the O of 18 Nov 2015 on health insurance surveillance, with effect from 1 Er Jan 2016 ( RO 2015 5165 ).
1 In the event of a dispute between the joint institution and an insurer, s. 87 of the law is applicable. L' al. 3 and art. 15 of the April 12, 1995 Order on Risk Compensation in Medicare 2 Are reserved. 3
2 In the event of a dispute between the common institution and a service provider, s. 89 of the law is applicable.
3 The joint institution shall decide in the form of a decision within the meaning of Art. 5 of the Federal Act of 20 December 1968 on administrative procedure 4 , in the event of a dispute between it and an insurer concerning:
4 The legal remedies are governed by the general provisions of the federal procedure. 6
1 New content according to the c. I of the O of Sept. 11. 2002, effective from 1 Er Jan 2003 ( RO 2002 3908 ).
2 RS 832.112.1
3 New content according to the c. I of the O of 26 Apr. 2006, effective 10 May 2006 ( RO 2006 1717 ).
4 RS 172.021
5 Introduced by ch. I of the O of 3 Dec. 2004 ( RO 2004 5075 ). New content according to the c. I of the O of 26 Apr. 2006, effective May 10, 2006 (RO 2006 1717).
6 Introduced by ch. I of the O of 26 Apr. 2006, effective 10 May 2006 ( RO 2006 1717 ).
1 Art. 20 and 21 shall apply mutatis mutandis to the supervision of the institution provided for in Art. 19, para. 2, of the law. The activity report is published.
2 The institution addresses the OFSP, along with the documents required for monitoring, its proposed contribution for the following year (s. 20, para. 1, LAMal). This proposal must be accompanied by an activity programme and a budget.
1 Repealed by c. 3 of the annex to the O of 18 Nov 2015 on health insurance surveillance, with effect from 1 Er Jan 2016 ( RO 2015 5165 ).
1 Judgments handed down by the cantonal courts of insurance (art. 57 LPGA and 87 LAMal), by the cantonal arbitral tribunals (art. 89 LAMal) and the Federal Administrative Tribunal for Social Insurance must be communicated to the OFSP.
2 The OFSP is entitled to appeal to the Federal Court against the judgments referred to in para. 1.
1 New content according to the c. II 95 of O of 8 nov. 2006 adapting O of the CF to the total revision of the federal procedure, in effect since 1 Er Jan 2007 ( RO 2006 4705 ).
1 Data provided by insurers in accordance with Art. 35, para. 2, of the Act of 26 September 2014 on the surveillance of health insurance (LSAMal) 2 Serve to: 3
2 The FOPH ensures that the communication of required data results in as little work as possible for insurers. In order to limit costs, it may combine this data with other data sources provided they have been made anonymous. It puts the results of the data sheets available to the bodies involved in the application of LAMal and the LSAMAL. 6
3 Insurers provide the FOPH, each year and by insured, with the following data:
4 They provide the data referred to in para. 3 using electronic data carriers. They may be exempted by the FOPH, at their request and for a limited period, insofar as they do not have the necessary technical means.
5 They provide the data at their own expense, in an accurate and complete manner, within the prescribed time frame, and in such a way that the anonymity of the insured is guaranteed.
6 They shall transmit to the OFSP, each year and at their own expense, the complete data from the register of the creditor code.
7 The FOPH, after consulting with the insurers, issues guidelines on actions to be taken under paras. 1 to 6.
1 New content according to the c. I of O du 22 oct. 2008, effective from 1 Er Jan 2009 ( RO 2008 5097 ).
2 RS 832.12
3 New content according to the c. 3 of the annex to the O of 18 Nov 2015 on the supervision of health insurance, in force since 1 Er Jan 2016 ( RO 2015 5165 ).
4 New content according to the c. 3 of the annex to the O of 18 Nov 2015 on the supervision of health insurance, in force since 1 Er Jan 2016 ( RO 2015 5165 ).
5 New content according to the c. 3 of the annex to the O of 18 Nov 2015 on the supervision of health insurance, in force since 1 Er Jan 2016 ( RO 2015 5165 ).
6 New content according to the c. 3 of the annex to the O of 18 Nov 2015 on the supervision of health insurance, in force since 1 Er Jan 2016 ( RO 2015 5165 ).
1 Introduced by ch. I of O du 22 oct. 2008 ( RO 2008 5097 ). Repealed by c. 3 of the annex to the O of 18 Nov 2015 on health insurance surveillance, with effect from 1 Er Jan 2016 (RO) 2015 5165).
1 The FOPH publishes the data referred to in s. 28 in such a way as to make it clear, in particular, information on forms of insurance, insurance benefits and costs distinguished by age, sex and region, and according to the categories of benefit providers, Facilities and care.
2 The OFSP publishes, by insurer, the following figures for social health insurance:
1 Introduced by ch. I of O du 22 oct. 2008, effective from 1 Er Jan 2009 ( RO 2008 5097 ).
In cases where insurance has lasted less than one year, the total number of insurance months divided by twelve is decisive for the calculation of the average number of insured persons to be disclosed by the insurers.
1 Repealed by c. I of O du 22 oct. 2008, with effect from 1 Er Jan 2009 ( RO 2008 5097 ).
The FOPH publishes the synthesis of data collected by the Federal Statistics Office under s. 59 A LAMal and the FOPH under s. 51 of the Federal Act of 23 June 2006 on University Medical Professions 2 , in such a way as to make it clear, in particular, the following information or figures of social health insurance, by benefit provider or by category of benefit providers: 3
1 New content according to the c. I of O du 22 oct. 2008, effective from 1 Er Jan 2009 ( RO 2008 5097 ).
2 RS 811.11
3 New content according to the c. 3 of the annex to the O of 18 Nov 2015 on the supervision of health insurance, in force since 1 Er Jan 2016 ( RO 2015 5165 ).
1 The FOPH, in collaboration with insurers, benefit providers, cantons and representatives of the scientific community, conducts scientific studies on the application and effects of the law.
2 The purpose of these studies is to influence the law on the situation and behaviour of policyholders, benefit providers and insurers. In particular, they are used to examine whether the quality and economic nature of basic health care is guaranteed and whether the objectives of social policy and competition are achieved.
3 In order to carry out these studies, the FOPH may use scientific institutes and appoint expert groups.
The Federal Department of the Interior (DFI) designates, after consulting the relevant committee: 1
1 New content according to the c. 3 of the annex to the O of 18 Nov 2015 on the supervision of health insurance, in force since 1 Er Jan 2016 ( RO 2015 5165 ).
2 New content according to the c. I of the O of 24 June 2009, in force since 1 Er Jan 2011 ( RO 2009 3525 6847 hp. II 2).
3 Introduced by c. I of the O of 24 June 2009, in force since 1 Er Jan 2011 ( RO 2009 3525 6847 hp. II 2).
4 Introduced by c. I of the O of 24 June 2009, in force since 1 Er Jan 2011 ( RO 2009 3525 6847 hp. II 2).
The lists referred to in s. 52, para. 1, paragraph a, c. 1 (list of analyses) and 2 (list of drugs), and let. B (list of specialities), of the law shall be established after consultation of the competent committee.
Therapeutic measures in cases of congenital infirmity (art. 52, para. 2, LAMal) must be taken care of by compulsory insurance, as soon as the insured person reaches the age at which the entitlement to disability insurance benefits ceases.
1 The DFI shall, after consulting the competent committee, designate the benefits provided for in Art. 25, para. 2, and 29 of the law whose costs incurred abroad are covered by compulsory insurance when they cannot be provided in Switzerland.
2 Compulsory care insurance covers the cost of treatment in the event of an emergency abroad. There is an emergency when the insured, who is temporarily living abroad, needs medical treatment and a return to Switzerland is not appropriate. There is no urgency when the insured person travels abroad for the purpose of following this treatment.
3 Compulsory insurance for care takes care of, within the framework of art. 29 of the law, the costs of childbirth that took place abroad when it is the only way to provide the child with the nationality of the mother or father, or when the child would be stateless if he was born in Switzerland.
4 The benefits referred to in paras. 1 and 2, and treatment abroad for frontier workers, posted workers and persons employed by a public service, as well as for members of their families (art. 3 to 5), are covered up to double the amount that would have been paid if the treatment had taken place in Switzerland; in the cases provided for in para. 3, the maximum amount corresponds to the amount that would have been paid in Switzerland. For insured persons under s. 4 and 5, the cost-taking is carried out on the basis of the rates and prices applicable to their last place of residence in Switzerland. If the treatment for insured persons referred to in s. 1, para. 2, let. D and e, do not follow the rules on international mutual assistance in the field of benefits, the assumption of costs shall be carried out on the basis of the rates and prices applicable to their last place of residence or work in Switzerland; if none of these places Cannot be determined, care shall be taken on the basis of the rates and prices applicable in the canton of the headquarters of the insurer. 1 2
5 The provisions on mutual assistance in the field of benefits remain reserved. 3
1 Phrase introduced by ch. I of the O of 3 Jul. 2001 ( RO 2002 915 ). New content according to the c. I of the O of 22 May 2002, in force since 1 Er June 2002 (RO 2002 1633).
2 New content according to the c. I of the O of June 15, 1998, in force since 1 Er August 1998 (RO 1998 1818).
3 Introduced by ch. I of the O of 3 Jul. 2001, effective from 1 Er June 2002 ( RO 2002 915 ).
1 The DFI may, in derogation from Art. 34 of the law, authorise pilot projects providing for the assumption by insurers of benefits provided abroad, in border areas, to persons resident in Switzerland.
2 The application must be filed four months prior to the proposed start of the pilot project.
3 The pilot project must meet the following requirements:
4 Insurers may waive the deductibles for benefits provided abroad, in whole or in part, from the deductibles (s. 103) and the contribution to hospital living expenses (art. 104).
5 The report resulting from the scientific monitoring is brought to the attention of the DFI.
1 Introduced by ch. I of the O of 26 Apr. 2006, effective 10 May 2006 ( RO 2006 1717 ).
2 New content according to the c. I of O du 15 oct. 2014, in force since 1 Er Nov 2014 ( RO 2014 3263 ). See also disp. And trans. On 24 June 2009 at the end of the text.
The insurer is responsible for the packages under s. 49, para. 1, of the law which is charged for the treatment of the following persons in a hospital listed in Switzerland:
1 New content according to the c. I of the O of 2 nov. 2011, in force since 1 Er Apr 2012 ( RO 2012 955 ).
Advisory Commissions within the meaning of Art. 33, para. 4, of the Act are:
1 New content according to the c. I of the O of 27 June 2007, in force since 1 Er Jan 2008 ( RO 2007 3573 ).
1 The Federal Council appoints the Chairman and the other members of the committees.
2 Each committee has a regulation. These rules rule in particular:
3 The participation of experts is mandatory when the panel reviews benefits provided by non-represented benefit providers.
4 The regulations are subject to approval by the DFI.
5 The DFI approves the constitution of the sub-committees. It shall designate the President and the other members.
6 The FOPH provides the secretariat of the commissions and ensures the coordination of their work. It may appoint third parties to provide the secretariat of the committees.
1 New content according to the c. I 2.10 of the O of 9 Nov 2011 (Review of the extra-parliamentary committees), in force since 1 Er Jan 2012 ( RO 2011 5227 ).
1 Repealed by c. I of the O of 27 June 2007, with effect from 1 Er Jan 2008 ( RO 2007 3573 ).
1 The Federal General Benefits Commission and the Principles advise the DFI for the designation of benefits under s. 33, for the development of the provisions to be enacted pursuant to s. 36, para. 1, 77, para. 4, and 104 A , para. 4, as well as for the evaluation of principles in medicare, taking into account the ethical aspects in the designation of benefits. 2
2 It is responsible in particular for the following tasks:
3 It consists of 18 members, namely:
1 New content according to the c. I of the O of 27 June 2007, in force since 1 Er Jan 2008 ( RO 2007 3573 ).
2 New content according to the c. 3 of the annex to the O of 18 Nov 2015 on the supervision of health insurance, in force since 1 Er Jan 2016 ( RO 2015 5165 ).
3 New content according to the c. I 2.10 of the O of 9 Nov 2011 (Review of the extra-parliamentary committees), in force since 1 Er Jan 2012 ( RO 2011 5227 ).
1 The Federal Drug Commission advises OFSP on the establishment of the list of specialties provided for by art. 34. It shall advise the DFI in the preparation of provisions in its field which are to be enacted pursuant to Art. 36, para. 1, 75, 77, para. 4, and 104 A , para. 4. 1
2 It consists of 16 members, including: 2
1 New content according to the c. 3 of the annex to the O of 18 Nov 2015 on the supervision of health insurance, in force since 1 Er Jan 2016 ( RO 2015 5165 ).
2 New content according to the c. I of the O of 18 Jan 2012, in force since 1 Er Feb 2012 ( RO 2012 459 ).
3 Introduced by c. I of the O of 18 Jan 2012, in force since 1 Er Feb 2012 ( RO 2012 459 )
4 New content according to the c. I 2.10 of the O of 9 Nov 2011 (Review of the extra-parliamentary committees), in force since 1 Er Jan 2012 ( RO 2011 5227 ).
1 The Federal Commission on Analyses, Means and Devices advises the DFI for the preparation of the list of analyses provided for in Art. 34, in the assessment and determination of the amount of the reimbursement of the means and apparatus referred to in s. 33, let. E, as well as in the elaboration of the provisions relating to its field to be enacted pursuant to Art. 36, para. 1, 75, 77, para. 4, and 104 A , para. 4. 2
2 It consists of 15 members, namely:
1 New content according to the c. I of the O of 27 June 2007, in force since 1 Er Jan 2008 ( RO 2007 3573 ).
2 New content according to the c. 3 of the annex to the O of 18 Nov 2015 on the supervision of health insurance, in force since 1 Er Jan 2016 ( RO 2015 5165 ).
3 New content according to the c. I 2.10 of the O of 9 Nov 2011 (Review of the extra-parliamentary committees), in force since 1 Er Jan 2012 ( RO 2011 5227 ).
1 Repealed by c. I of the O of 27 June 2007, with effect from 1 Er Jan 2008 ( RO 2007 3573 ).
Physicians must prove that they hold a post-grade title within the meaning of s. 20 of the Federal Act of 23 June 2006 on the Medical Professions (LPMed) 1 .
1 Physicians holding a foreign degree recognized within the meaning of s. 15 LPMed 1 , have the same rights as doctors with a corresponding federal degree.
2 Physicians holding a foreign post-degree title recognized within the meaning of s. 21 LPMed or Cantonal authorization to practice on an independent basis pursuant to s. 36, para. 3, LPMéd, have the same rights as the doctors holding a corresponding federal post-grade title.
Pharmacists must demonstrate that they have completed two years of practical training in a pharmacy.
Dentists with a federal degree who can provide two-year practical training in a dentist's office or dental institute are eligible.
1 Chiropractors must prove:
3 The provisions relating to the use of ionising radiation in chiropracticism are reserved. 11 of the Radiation Protection Order of 22 June 1994 4 .
1 RS 811.11
2 New content according to Art. 17 of the O of 27 June 2007 concerning diplomas, university training, postgraduate training and the exercise of the academic medical professions, in force since 1 Er Seven. 2007 ( RO 2007 4055 ).
3 Repealed by Art. 17 of the O of 27 June 2007 concerning diplomas, university training, postgraduate training and the exercise of the university medical professions, with effect from 1 Er Seven. 2007 ( RO 2007 4055 ).
4 RS 814.501
1 Midwives must:
1 See also disp. End. Mod. Dec 3. 2004, at the end of the text.
2 New content according to the c. I of the O of 3 Dec. 2004, in effect since 1 Er Jan 2005 ( RO 2004 5075 ). See also disp. End. Of this mod. At the end of the text.
3 RS 412.10
4 Repealed by c. I of the O of 3 Dec. 2004, with effect from 1 Er Jan 2005 ( RO 2004 5075 ).
1 The following persons shall be admitted as persons providing medical prescription care on an independent basis and on their own account:
2 Such persons must be admitted under the cantonal law and comply with the other conditions of admission laid down in this order.
1 Introduced by c. I of the O of 25 Nov 1996, in force since 1 Er Jan 1997 (RO) 1996 3139).
1 Physiotherapists must:
1 See also disp. End. Mod. Dec 3. 2004, at the end of the text.
2 New content according to the c. I of the O of 3 Dec. 2004, in effect since 1 Er Jan 2005 ( RO 2004 5075 ). See also disp. End. Of this mod. At the end of the text.
3 RS 412.10
4 New content according to the c. I of the O of 24 June 2009, in force since 1 Er August 2009 ( RO 2009 3525 ).
5 Repealed by c. I of the O of 3 Dec. 2004, with effect from 1 Er Jan 2005 ( RO 2004 5075 ).
1 Occupational therapists must:
1 New content according to the c. I of the O of 3 Dec. 2004, in effect since 1 Er Jan 2005 ( RO 2004 5075 ). See also disp. End. Of this mod. At the end of the text.
2 RS 412.10
3 Repealed by c. I of the O of 3 Dec. 2004, with effect from 1 Er Jan 2005 ( RO 2004 5075 ).
Nurses must:
1 New content according to the c. I of the O of 3 Dec. 2004, in effect since 1 Er Jan 2005 ( RO 2004 5075 ). See also disp. End. Of this mod. At the end of the text.
2 RS 412.10
Logoperdists/speech-language pathologists must:
1 New content according to the c. I of the O of 25 Nov 1996, in force since 1 Er Jan 1997 (RO) 1996 3139).
1 Dietitians must:
1 Introduced by ch. I of the O of 25 Nov 1996, in force since 1 Er Jan 1997 (RO) 1996 3139). See also disp. End. Of this mod. At the end of the text.
2 New content according to the c. I of the O of 3 Dec. 2004, in effect since 1 Er Jan 2005 ( RO 2004 5075 ).
3 RS 412.10
4 New content according to the c. I of the O of 4 Jul. 2012, effective from 1 Er Jan 2013 ( RO 2012 4089 ).
5 Repealed by c. I of the O of 3 Dec. 2004, with effect from 1 Er Jan 2005 ( RO 2004 5075 ).
Organizations that provide home care and support are allowed when they:
1 New content according to the c. I of the O of 17 Sept. 1997, effective from 1 Er Jan 1998 (RO) 1997 2272).
2 New content according to the c. I of the O of 17 Sept. 1997, effective from 1 Er Jan 1998 (RO) 1997 2272).
3 New content according to the c. I of the O of 17 Sept. 1997, effective from 1 Er Jan 1998 (RO) 1997 2272).
4 New content according to the c. I of the O of 17 Sept. 1997, effective from 1 Er Jan 1998 (RO) 1997 2272).
Organisations of occupational therapy are admitted when they:
1 New content according to the c. I of the O of 17 Sept. 1997, effective from 1 Er Jan 1998 (RO) 1997 2272).
2 New content according to the c. I of the O of 17 Sept. 1997, effective from 1 Er Jan 1998 (RO) 1997 2272).
3 New content according to the c. I of the O of 17 Sept. 1997, effective from 1 Er Jan 1998 (RO) 1997 2272).
4 New content according to the c. I of the O of 17 Sept. 1997, effective from 1 Er Jan 1998 (RO) 1997 2272).
Physiotherapy organizations are admitted when they:
1 Introduced by ch. I of the O of 24 June 2009, in force since 1 Er August 2009 ( RO 2009 3525 ).
Dietetic organizations are admitted when they:
1 Introduced by ch. I of the O of 4 Jul. 2012, effective from 1 Er Jan 2013 ( RO 2012 4089 ).
Establishments that are admitted as laboratories are:
1 New content according to Art. 27 ch. 1 of the O of 29 Apr. 2015 on microbiology laboratories, in force since 1 Er Jan 2016 ( RO 2015 1497 ).
2 Introduced by Art. 37 hp. 2 of the O of 14 February 2007 on human genetic analysis, in force since 1 Er Apr 2007 ( RO 2007 651 ).
1 Are admitted without further conditions as medical laboratories:
2 Hospital laboratories that carry out analyses only for the needs of the hospital are admitted if they are under the direction of a doctor, pharmacist or official with university education in the natural sciences Recognised by the DFI or a superior training suitable for the practice of analyses recognised by the DFI.
3 Laboratories mandated by another provider of benefits who are admitted and who perform other tests other than those performed in basic care are admitted when:
4 The DFI may provide for the execution of certain analyses of additional requirements for facilities, qualification and postgraduate training of management and laboratory personnel. It may also designate certain institutions to carry out specific analyses and instruct them to maintain evaluation records.
5 The DFI may issue implementing provisions for para. 1, let. A. 3
1 Introduced by ch. I of the O of 29 Nov 2013, in force since 1 Er Jan 2014 ( RO 2013 4523 ).
2 New content according to the c. I of the O of 6 June 2003, in force since 1 Er Jan 2004 ( RO 2003 3249 ).
3 Introduced by ch. I of the O of 6 June 2003, in force since 1 Er Jan 2004 ( RO 2003 3249 ).
The person who is admitted under the cantonal law and who enters into a contract on the handing over of diagnostic or therapeutic means and apparatus with a sickness insurance company is authorised to carry on his activity at the expense of that insurer.
Birthhouses are allowed when they:
The person who is admitted under the cantonal law and who enters into a contract on transport and rescue with a sickness insurance company is authorised to carry on the activity of that insurer.
1 The bathing establishments are admitted when they are placed under medical supervision, use the thermal springs of the place for therapeutic purposes, are equipped with the necessary specialised staff and of diagnostic facilities, and And that they are admitted under the cantonal law.
2 The DFI may authorize exceptions to the requirement for the use of the hot springs at the site. In so doing, it takes into account the previous practice of insurers.
1 Hotsprings are considered to be those whose water, by reason of a particular chemical or physical property and without having undergone any modification in its natural composition, exerting or allows to wait for a scientifically recognised curative effect.
2 The chemical or physical properties of the thermal waters shall be demonstrated by means of expertise and reviewed every three years by means of control analyses carried out by the competent cantonal authority.
1 Planning to cover health care needs (art. 39, para. 1, let. D, LAMal) guarantees to the inhabitants of the cantons who establish the hospital treatment at the hospital or in a house of birth and the treatment in a medical-social institution.
2 The cantons periodically review their schedules.
1 The cantons determine the needs according to a verifiable approach. They are based, in particular, on statistically justified data and on comparisons.
2 They determine the offer used in institutions that are not on the list they have arrested.
3 They determine the offer to be guaranteed by the listing of cantonal and extra-cantonal establishments on the list referred to in Art. 58 E So that the coverage of needs is assured. This offer corresponds to the needs determined in accordance with para. 1, net of the offer determined in accordance with para. 2.
4 In assessing and selecting the offer to be guaranteed by the list, the cantons shall take into account, in particular:
5 In examining the economic character and quality, the cantons shall take particular account of:
The schedule is as follows:
As part of the obligation of inter-cantonal coordination of planning, referred to in Art. 39, para. 2, of the law, the cantons must in particular:
1 The cantons shall enter on their list referred to in Art. 39, para. 1, let. E of the law, the cantonal and extra-cantonal establishments necessary to guarantee the supply determined in accordance with Art. 58 B , para. 3.
2 The lists refer to the range of benefits for each hospital for the benefit mandate.
3 The cantons give each establishment on their list a mandate for benefits within the meaning of Art. 39, para. 1, let. The law. This may include an obligation to have an emergency service.
1 Benefit providers must include on their invoices all the administrative and medical indications necessary to verify the calculation of the remuneration and the economic nature of the benefits in accordance with Art. 42, para. 3 and 3 Bis , of the law. In particular, they must provide the following information:
2 The benefit provider must establish two separate invoices, one for the benefits paid by the compulsory health insurance and the other for the other benefits.
3 For analyses, the invoice to the debtor of the remuneration shall be drawn up exclusively by the laboratory which carried out the analyses. Lump-sum rates according to s. 49 of the Act are reserved.
4 If the insurers and the benefit providers have agreed that the insurer is the payer of the remuneration (system of the paying third party), the benefit provider must provide the insured person with a copy of the invoice provided for in s. 42, para. 3, of the law. The insurer may agree with the insurer that the insurer will forward the copy of the invoice.
1 In the case of a pay model of type DRG ( Diagnosis Related Groups ), the benefit provider must provide a unique identification number with the data files with the administrative and medical indications referred to in Art. 59, para. 1. The DFI establishes the uniform structure at Swiss level of data files.
2 The diagnoses and procedures referred to in Art. 59, para. 1, let. C, should be coded according to the classifications mentioned for hospital medical statistics in c. 62 of the annex to the order of 30 June 1993 on statistical statements 2 .
3 The service provider shall simultaneously transmit with the invoice the data files with the administrative and medical indications referred to in Art. 59, para. 1, to the Insurer's data reception service. It must be ensured that only this data reception service obtains access to medical indications.
4 The data reception service determines for which invoices a more detailed examination is required and forwards to the Insurer the indications necessary for this purpose. The Insurer may not provide the receipt of data, for individual invoices, with instructions concerning the transmission of the data.
5 If additional medical information within the meaning of s. 42, para. 4, of the Act is required of the supplier of benefits by the insurer during the course of the examination, the insurer must inform the insured person of the options available to the insurer under s. 42, para. 5, of the law.
6 Each insurer must have a data reception service. The latter must be certified within the meaning of s. 11 of the Federal Act of 19 June 1992 on Data Protection 3 .
7 The insurer spontaneously informs the employee of the art. 26 of the Federal Act of 19 June 1992 on the protection of data from the certification of its data reception service or the renewal of certification. The agent may require at any time the data reception service or the certification body the documents determining the certification or renewal of the certification. The attendant publishes a list of certified data receipt services.
For the ambulatory domain and the fields of rehabilitation and psychiatry, the DFI lays down detailed provisions on the collection, processing and transmission of diagnoses and procedures, in accordance with the principle of Proportionality. It sets out the coding classifications applicable throughout Switzerland.
1 Introduced by ch. I of the O of 4 Jul. 2012 ( RO 2012 4089 ). New content according to the c. I of the O of 19 Nov 2014, in force since 1 Er Jan 2015 (RO) 2014 4391, 2015 1177). See also disp. And trans. Of this mod.
1 For the treatment of medical indications referred to in Art. 59, para. 1, insurers shall take the technical and organisational measures necessary to ensure the security of the data, in particular those referred to in Art. 21 and 22 of the Order of 14 June 1993 on the Federal Data Protection Act 2 .
2 Where the medical indications referred to in s. 59, para. 1, are not stored in encrypted form, the identity of the insured must be pseudonymous for the conservation of these indications. Nicknames or encryption can be removed only by the Medical Officer.
1 Introduced by ch. I of the O of 4 Jul. 2012, effective from 1 Er Jan 2013 ( RO 2012 4089 ).
2 RS 235.11
1 Introduced by ch. I 8 of the O of 18 August 2004 ( RO 2004 4037 ). Repealed by c. I of the O of 29 Apr. 2015, with effect from 1 Er June 2015 (RO 2015 1255).
1 The approval authority within the meaning of s. 46, para. 4, of the Act verifies that the tariff agreement respects the following principles in particular:
2 Parties to a convention must regularly check tariffs and adapt them if compliance with the principles set out in para. 1, let. A and b, is no longer guaranteed. The competent authorities must be informed of the results of these verifications.
3 The competent authority shall apply paras. 1 and 2 when fixing the rates laid down in Art. 43, para. 5, 47, or 48 of the Act.
1 Introduced by ch. I of the O of 27 June 2007, in force since 1 Er August. 2007 ( RO 2007 3573 ).
1 Tariff partners must submit the tariff agreement to the Federal Council for approval in accordance with ss. 46, para. 4, and 49, para. 2, of the law. The tariff agreement must contain the uniform tariff structure and the manner in which the tariff is to be applied. The application for approval must include the following documents:
2 In the case of a benefit-compensation model based on a classification system for patients of type DRG ( Diagnosis Related Groups ), the tariff agreement also includes the coding manual as well as a concept for the revision of the coding. The application for approval must be accompanied by additional documentation on the requirements to be met by hospitals in order to be considered for the development of the fee structure.
3 The tariff partners shall submit to the Federal Council for approval the adjustments to the tariff agreement, including the tariff structure or the manner in which the tariff is to be applied.
4 The relationship to be established with the benefit within the meaning of s. 49, para. 1, of the law, must permit differentiation of the tariff according to the nature and intensity of the benefit.
1 Introduced by ch. I of O du 22 oct. 2008, effective from 1 Er Jan 2009 ( RO 2008 5097 ). See also disp. End. Of this mod. At the end of the text.
1 In the event of the collection of a contribution per case in accordance with Art. 49, para. 2, of the law, the tariff partners must submit the amount to the Federal Council for approval. The application must be accompanied by an activity report of the organization and a budget that justifies the amount.
2 In the event of an increase in the contribution, the tariff partners shall submit it again to the Federal Council for approval.
3 Art. 49 A , para. 1 and 2, of the Act applies mutatis mutandis to the allocation of funding for the contribution on a case-by-case basis.
1 Introduced by ch. I of O du 22 oct. 2008, effective from 1 Er Jan 2009 ( RO 2008 5097 ). See also disp. End. Of this mod. At the end of the text.
List of analyses (art. 52, para. 1, paragraph a, c. 1, LAMal) appears in principle every year. The title and the reference are published in the Official Code of Federal Law.
1 New content according to the c. I of the O of 26 June 2002, in force since 1 Er Jul. 2002 ( RO 2002 2129 ).
1 Proposals to have an analysis accepted in the list can be submitted to the FOPH.
2 The FOPH reviews the proposal and submits it to the appropriate committee. When considering proposals, it may involve external experts. It may, on its own initiative or on a proposal from the competent committee, make the admission of an analysis subject to supplementary examinations.
3 Analyses that do not meet the eligibility criteria are removed from the list.
1 DFI refers to analyses that:
2 DFI refers to tests performed in the laboratory of the physician for which the tariff may be fixed in accordance with s. 46 and 48 of the Act.
1 New content according to the c. I of the O of 23 Feb 2000, in force since 1 Er Apr 2000 ( RO 2000 889 ).
1 List of drugs with a tariff (s. 52, para. 1, paragraph a, c. 2, LAMal) appears in principle every year. The title and the reference are published in the Official Code of Federal Law.
2 The provisions relating to the list of specialities shall apply mutatis mutandis to admission to the list of medicines with tariffs.
1 Repealed by c. I of the O of 29 Apr. 2015, with effect from 1 Er June 2015 ( RO 2015 1255 ).
1 A medicinal product whose active substance has been authorised first by Swissmedic, the Swiss Institute for Therapeutic Products (institute), including any galenic form authorised at the same time or at a later stage, is deemed to be an original preparation.
2 Every medicinal product authorised by the Institute shall be deemed to be generic, which essentially is similar to an original preparation and which is interchangeable with it because it has an active substance, a galenic form and an identical dosage.
3 It is deemed to be a drug in co-marketing any medicinal product authorised by the Institute which does not differ from another medicinal product authorised by the Institute (basic preparation) except by the name and packaging.
1 Introduced by ch. I of the O of 26 Apr. 2006, effective 10 May 2006 ( RO 2006 1717 ).
1 A medicinal product may be admitted to the list of specialities if it has valid authorisation from the institute.
2 Drugs that are advertised to the public within the meaning of s. 2, let. B, of the order of 17 October 2001 on advertising for medicinal products 2 , are not allowed in the list of specialties.
3 Drugs must be effective, appropriate and economical.
4 The holder of the marketing authorisation of an original preparation must submit to the OFSP, together with the application for admission to the list of specialities, the number of the patents, that of the supplementary protection certificates and their date Of expiration. 3
5 The FOPH may include conditions and charges for admission, including:
1 New content according to the c. I of O of 1 Er Jul. 2009, effective from 1 Er Oct. 2009 ( RO 2009 4245 ).
2 RS 812.212.5
3 New content according to the c. I of the O of 29 Apr. 2015, in force since 1 Er June 2015 ( RO 2015 1255 ).
4 New content according to the c. I of the O of 29 Apr. 2015, in force since 1 Er June 2015 ( RO 2015 1255 ).
Evaluation of the efficacy of allopathic medicines must be based on controlled clinical studies.
1 Introduced by ch. I of the O of 26 Apr. 2006 ( RO 2006 1717 ). New content according to the c. I of O of 1 Er Jul. 2009, effective from 1 Er Oct. 2009 (RO 2009 4245).
1 A drug is deemed to be economic when it produces the desired therapeutic effect at the lowest possible cost.
2 The economic character is assessed on the basis of the following comparisons:
A. Comparison with prices in reference countries (comparison with foreign prices);
B. Comparison with the price and effectiveness of other drugs.
3 The comparison with foreign prices is based on the factory price. If the factory price is not public, the cost price is used for the pharmacies or, if it is not public, the wholesale price, by deducting the margins from the wholesalers. DFI determines the amount of the deduction based on the average margins of the wholesalers. It can provide that actual margins are deducted instead.
4 The discounts imposed on manufacturers in the reference countries are deducted from the factory price. The amount of the deduction is determined by the DFI. It may provide that the actual discount is deducted instead.
5 In assessing the economic character of a medicinal product, the average price in the reference countries accounts for two-thirds and the price of other medicines for a third party. The result of this weighting may not exceed by more than 5 % the average price in the reference countries, unless the medicinal product is of great importance to guarantee medical care or the comparison with the prices charged to The foreign national can only be carried out in less than three countries of reference.
6 In assessing the economic character of an original preparation, the costs of research and development shall also be taken into account, except where the preparation concerned follows an original preparation in the list of Specialties without making therapeutic progress.
7 If the medicinal product is an important therapeutic advance, a premium to innovation is taken into account when assessing the economic character.
1 Introduced by ch. I of the O of 26 Apr. 2006 ( RO 2006 1717 ). New content according to the c. I of the O of 29 Apr. 2015, in force since 1 Er June 2015 (RO 2015 1255).
1 In assessing the economic nature of generics, account is taken of the fact that development costs are lower than for original preparations.
2 On admission to the list of specialities, a generic is deemed to be economic if its factory price is less than the following proportions in the original preparation with which it is interchangeable:
3 The average level of foreign prices on the expiry date in Switzerland of the patent of the original preparation, calculated on the basis of its most sold packaging, is decisive for the calculation of the generic factory price. 3
4 The volume of market in Switzerland per year within the meaning of para. 2 is calculated on the basis of the factory price of the original preparation and its drug in co-marketing and includes all the commercial forms of the same active substance. When responding to the application for the admission of a generic in the list of specialities, the FOPH may require the holder of the authorisation to indicate the volume of the market in Switzerland. It must be based on statements made by an independent institute. 4
5 The generic prices allowed in the list of specialties prior to the review of the price of the original preparation in accordance with Art. 65 E , are adapted after the price review so as to maintain this gap.
1 Introduced by ch. I of the O of 26 Apr. 2006 ( RO 2006 1717 ). New content according to the c. I of O of 1 Er Jul. 2009, effective from 1 Er Oct. 2009 (RO 2009 4245).
2 New content according to the c. I of the O of 29 Apr. 2015, in force since 1 Er June 2015 ( RO 2015 1255 ).
3 New content according to the c. I of the O of 29 Apr. 2015, in force since 1 Er June 2015 ( RO 2015 1255 ).
4 New content according to the c. I of the O of 29 Apr. 2015, in force since 1 Er June 2015 ( RO 2015 1255 ).
1 The FOPH reviews every three years if the drugs listed in the list of specialties still meet the conditions of admission. The drugs are divided into three blocks on the basis of their membership in a therapeutic group in the list of specialties. Each block is reviewed every three years.
2 The FOPH will review on its own initiative or on a proposal from the Federal Drug Commission the effectiveness or appropriateness of a drug when there is evidence to suggest that the drug may no longer meet any of these criteria.
3 In the review of the economic character of original preparations, comparison with other medicinal products shall be made only in the following cases:
4 The comparison with foreign prices is based on the packaging generating the highest turnover.
5 If the review of the economic character shows that the maximum current price is too high, the OFSP orders an appropriate price reduction, which takes effect on 1 Er September of the year of review. To calculate the percentage decrease, the average prices of the reference countries account for two thirds and the factory price in force for a third party.
6 The holder of the authorisation shall communicate all necessary information to the OFSP.
7 If the FOPH reviews the medicinal products with which the comparison is made at the same time, it shall inform the holder of the authorisation of the price for these other medicinal products as of 1 Er September.
8 The FOPH shall inform the holder of the authorisation of a generic price for the original preparation from 1 Er September.
1 Introduced by ch. I of O of 1 Er Jul. 2009 ( RO 2009 4245 ). New content according to the c. I of the O of 29 Apr. 2015, in force since 1 Er June 2015 (RO 2015 1255). See also disp. And trans. Of this mod. At the end of the text.
1 As soon as patent protection has expired, the FOPH will re-examine whether the original preparations still meet the conditions for admission. Process patents are not considered in the review.
2 Economic character is reviewed exclusively on the basis of comparison with foreign prices.
3 The costs of research and development are no longer taken into account in the review of economic character.
4 If the economic review shows that the current maximum price is too high, the OFSP orders a price reduction to bring it back to the average factory price level in the reference countries.
1 Introduced by ch. I of O of 1 Er Jul. 2009 ( RO 2009 4245 ). New content according to the c. I of the O of 29 Apr. 2015, in force since 1 Er June 2015 (RO 2015 1255).
1 Where the Institute authorizes a new indication for an original preparation or the holder of the authorization requests the modification or deletion of a limitation fixed for an original preparation due to an extension of the Indications, the FOPH examines once again whether this preparation meets the conditions for admission to the list of specialities.
2 The original preparation shall be deemed to be economic until the examination of the conditions of admission laid down in Art. 65 D If the holder of the authorisation proposes to waive 35 % of the estimated amount of the additional turnover; the amount to which it renounces is converted into a decrease in the factory price of the preparation. This rule does not apply to original preparations for which the quantity of additional packaging estimated is more than 100 times greater than the quantity of packaging sold before the admission of the new indication in the list of Or when it is not possible to estimate the additional turnover due to insufficient data.
3 Two years after the estimate of the additional turnover within the meaning of para. 2, the OFSP verifies that this estimate corresponds to the reality. If it is found that the estimated amount has been exceeded, the OFSP orders an appropriate price reduction.
4 If the holder of the authorisation does not make a proposal within the meaning of para. 2, 1 Re Phrase, or if the conditions of para. 2, 2 E The FOPH shall carry out an assessment of the economic nature of the preparation within the meaning of Art. 65 B .
5 Where the Institute authorizes a new indication for an original preparation, the holder of the authorization must communicate this extension to the FOPH within 90 days. The FOPH may set an appropriate additional time limit and require the submission of documents defined by the DFI for reconsideration of the conditions of admission.
6 If the conditions of admission for the new indication are not met, the OFSP may limit the original preparation to the permitted indication.
1 Introduced by ch. I of the O of 8 May 2013 ( RO 2013 1353 ). New content according to the c. I of the O of 29 Apr. 2015, in force since 1 Er June 2015 (RO 2015 1255). See also disp. And trans. Of the mod. On 8 May 2013 at the end of the text.
1 If the institute restricts the indication of an original preparation, the OFSP immediately adapts the limitation in the list of specialities. It can then re-examine once again that the conditions for admission are fulfilled and require the authorisation holder to obtain the necessary documents for that purpose.
2 If OFSP does not conduct a review under para. 1, the original preparation as well as its generic and co-marketing medicines are deemed to be economic until the examination of the conditions of admission within the meaning of Art. 65 D . The restriction of the indication cannot lead to an increase in the price of the preparation.
3 The holder of the authorisation shall inform the OFSP of any restriction of the indication by the Institute within 30 days and shall provide it within 90 days with the documents defined by the DFI.
1 Introduced by ch. I of the O of 29 Apr. 2015, in force since 1 Er June 2015 ( RO 2015 1255 ).
The price reviews provided for in s. 65 A At 65 G Are performed independently of each other. The price can be lowered several times in the same calendar year.
1 New content according to the c. I of the O of 29 Apr. 2015, in force since 1 Er June 2015 ( RO 2015 1255 ).
The FOPH may verify at any time after the admission of a medicinal product in the list of specialities that it still meets the conditions laid down in Art. 65, para. 1 to 3.
1 Introduced by ch. I of the O of 26 Apr. 2006 ( RO 2006 1717 ). New content according to the c. I of the O of 29 Apr. 2015, in force since 1 Er June 2015 (RO 2015 1255).
1 If an original preparation under s. 65 A At 65 G Is also the basic preparation of a drug in co-marketing, the latter is reviewed at the same time as the basic preparation. A co-marketing drug is deemed to be economic if its price does not exceed that of the basic preparation.
2 If, in a review within the meaning of s. 65 F Or 65 G , an original preparation is subject to a limitation or modification of the limitation, the OFSP orders the same limitation for its generics and medicines in co-marketing.
1 Introduced by ch. I of the O of 26 Apr. 2006 ( RO 2006 1717 ). New content according to the c. I of the O of 29 Apr. 2015, in force since 1 Er June 2015 (RO 2015 1255).
1 The list of specialties contains the maximum price determinants for drug delivery by pharmacists, physicians, hospitals and medico-social institutions. 2
1 Bis The maximum price consists of the factory price and the distribution share. 3
1 Ter The factory price pays the benefits, including royalties, from the manufacturer and the distributor to the exit of the warehouse, in Switzerland. 4
1 Cc The distribution share pays for logistical benefits. It consists of:
2 The prices fixed in the list of specialities can only be increased by the authorization of the OFSP. It shall be granted only if the following conditions are met:
1 See disp. End. Mod. 2 Oct. 2000, at the end of the text.
2 New content according to the c. I of O du 2 oct. 2000, in force since 1 Er Jan 2001 ( RO 2000 2835 ).
3 Introduced by ch. I of O du 2 oct. 2000, in force since 1 Er Jan 2001 ( RO 2000 2835 ).
4 Introduced by ch. I of O du 2 oct. 2000, in force since 1 Er Jan 2001 ( RO 2000 2835 ).
5 Introduced by ch. I of O du 2 oct. 2000 ( RO 2000 2835 ). New content according to the c. I of O of 1 Er Jul. 2009, effective from 1 Er Oct. 2009 (RO 2009 4245). See also disp. And trans. Of this mod. At the end of the text.
6 New content according to the c. I of the O of 29 Apr. 2015, in force since 1 Er June 2015 ( RO 2015 1255 ).
7 Introduced by ch. I of the O of 26 June 2002 ( RO 2002 2129 ). Repealed by c. I of O of 1 Er Jul. 2009, with effect from 1 Er Oct. 2009 (RO 2009 4245).
8 Introduced by ch. I of the O of 26 June 2002 ( RO 2002 2129 ). Repealed by c. I of the O of 29 Apr. 2015, with effect from 1 Er June 2015 (RO 2015 1255). See also disp. And trans. Of this mod. At the end of the text.
9 Repealed by c. I of O of 1 Er Jul. 2009, with effect from 1 Er Oct. 2009 ( RO 2009 4245 ).
10 Introduced by ch. I of the O of 25 Nov 1996 (RO 1996 3139). Repealed by c. I of O du 2 oct. 2000, with effect from 1 Er Jan 2001 (RO) 2000 2835).
1 If the factory price on which the maximum price is based on the admission of a medicinal product in the list of specialities is more than 3 % above the factory price calculated during the review of the economic character and the excess of Revenue thus realised at least 20 000 francs, the holder of the marketing authorisation shall be required to reimburse the excess of revenue collected since the admission to the joint institution provided for in Art. 18 LAMal.
2 The holder of the authorisation shall be required to reimburse the common institution for the excess of revenue it has earned:
1 Introduced by ch. I of the O of 29 Apr. 2015, in force since 1 Er June 2015 ( RO 2015 1255 ).
1 A medicine from the list of specialties is written off: 1
2 The cancellation takes effect three months after being published in the FOPH newsletter (art. 72, let. (a). If justified by particular reasons, it shall take effect at the same time as publication.
1 New content according to the c. I of the O of 26 Apr. 2006, effective 10 May 2006 ( RO 2006 1717 ).
2 New content according to the c. I of O of 1 Er Jul. 2009, effective from 1 Er Oct. 2009 ( RO 2009 4245 ).
3 Introduced by c. I of the O of 26 June 2002 ( RO 2002 2129 ). New content according to the c. I of the O of 29 Apr. 2015, in force since 1 Er June 2015 (RO 2015 1255).
4 Introduced by c. I of the O of 26 June 2002, in force since 1 Er Jul. 2002 ( RO 2002 2129 ).
5 Introduced by c. I of the O of 8 May 2013 ( RO 2013 1353 ). New content according to the c. I of the O of 29 Apr. 2015, in force since 1 Er June 2015 (RO 2015 1255).
6 Introduced by c. I of the O of 8 May 2013 ( RO 2013 1353 ). New content according to the c. I of the O of 29 Apr. 2015, in force since 1 Er June 2015 (RO 2015 1255).
1 Applications for admission of a ready-made drug to the list of specialties must be filed with the FOPH.
2 A new application must be filed for any modification of a medicinal product listed in the list of specialities or its price. Where the composition of the active substances has been amended, the amended instrument of authorisation of the Institute shall be attached to the application. 2
3 The documentation attached to the application must show that the conditions of admission are met.
4 The application for admission to the list of specialities may be filed where the data on indications and dosages confirmed by the Institute in the context of the notice referred to in Art. 6 of the order of 17 October 2001 on medicinal products 3 Are available. The FOPH reviews the application as soon as the complete documentation is in its possession. 4
1 New content according to the c. I of the O of 26 June 2002, in force since 1 Er Jul. 2002 ( RO 2002 2129 ).
2 New content according to the c. I of the O of 26 Apr. 2006, effective 10 May 2006 ( RO 2006 1717 ).
3 RS 812.212.21
4 New content according to the c. I of the O of 26 Apr. 2006, effective 10 May 2006 ( RO 2006 1717 ).
1 Introduced by ch. I of the O of 26 June 2002 ( RO 2002 2129 ). Repealed by c. I of the O of 27 June 2007, with effect from 1 Er August. 2007 (RO 2007 3573).
The FOPH may enter or maintain in the list of specialities a medicinal product or indication of a medicinal product which has been authorised by the Institute, even where the holder of the authorisation has not requested their registration or has requested their registration Radiation, if the drug or indication is of great importance to ensure medical care. He determines the price.
1 New content according to the c. I of the O of 29 Apr. 2015, in force since 1 Er June 2015 ( RO 2015 1255 ).
The DFI enacts regulations governing:
1 Introduced by ch. I of O of 1 Er Jul. 2009, effective from 1 Er Oct. 2009 ( RO 2009 4245 ).
2 New content according to the c. I of the O of 29 Apr. 2015, in force since 1 Er June 2015 ( RO 2015 1255 ).
3 Introduced by c. I of the O of 29 Apr. 2015, in force since 1 Er June 2015 ( RO 2015 1255 ).
1 Fees are collected for decisions concerning the inscription in the list of specialities and for the registration itself. The amounts of the fees are set out in Annex 1.
2 Extraordinary disbursements, in particular where they are attributable to external expertise relating to medical or economic matters, may be invoiced in addition. The hourly rate is 200 francs.
3 As far as extraordinary costs are concerned, the FOPH may receive emoluments according to the time invested. The hourly rate varies from 100 to 250 francs based on the required knowledge.
4 Moreover, the provisions of the General Order of 8 September 2004 on emoluments 2 Are applicable.
1 Formerly art. 71. New content according to c. I of the O of 8 May 2013, in force since 1 Er Jan 2014 ( RO 2013 1353 ).
2 RS 172.041.1
1 The FOPH publishes the list of specialities (art. 52, para. 1, let. B, LAMal).
2 In the case of the admission of a medicinal product to the list of specialities, to an extension of the indications or to a modification of the limitation within the meaning of Art. 65 F , it publishes the elements on which the assessment of the efficacy and suitability of the medicinal product is based, the comparison with the price of other medicinal products (art. 65 B , para. 2, let. (b) and the innovation premium (art. 65 B , para. 7).
3 In the case of an admission for a limited period within the meaning of Art. 65, para. 5, let. A, it publishes the duration of admission.
4 If an appeal is lodged against a decision of the FOPH, the latter may publish the name of the medicinal product concerned.
5 When conducting a re-examination of the conditions of admission upon expiry of a patent, it shall publish the factory prices of the original preparation calculated in comparison with the foreign prices.
6 Publications referred to in paras. 1 to 5 are performed on a public online platform 2 .
1 Introduced by ch. I of the O of 29 Apr. 2015, in force since 1 Er June 2015 ( RO 2015 1255 ). See also disp. And trans. Of this mod. At the end of the text.
2 The documents are available at www.ofsp.admin.ch > Topics > Health Insurance > Prices and Prices > List of Specialties
1 The compulsory health insurance shall bear the costs of a medicinal product admitted in the list of specialities and used for a further indication than that authorised by the Institute or provided for by the limitation laid down in the list of specialities, to the Meaning of s. 73, if:
2 It only takes care of the costs of the drug if the insurer has given a special guarantee after consulting the Medical Officer.
3 The relationship between the amount to be repaid and the therapeutic benefit of the drug must be adequate. The insurer fixes the amount of the rebate. The maximum price is the one shown in the list of specialities.
1 Introduced by ch. I of the O of 2 Feb 2011, in force since 1 Er March 2011 ( RO 2011 653 ).
1 The compulsory health insurance covers the costs of a drug ready for use authorised by the institute when it is not on the list of specialities and is used for the indications mentioned on the notice or outside of the If the conditions referred to in s. 71 A , para. 1, let. A or b, are completed.
2 It shall bear the costs of a medicinal product not authorised by the Institute but which may be imported under the LPTh if the conditions referred to in Art. 71 A , para. 1, let. A or b, are fulfilled and the medicinal product is authorised for the corresponding indication by a State having established an equivalent system of marketing authorisation recognised by the Institute.
3 It only takes care of the costs of the drug if the insurer has given a special guarantee after consulting the Medical Officer.
4 The relationship between the amount to be repaid and the therapeutic benefit of the drug must be adequate. The insurer fixes the amount of the rebate.
1 Introduced by ch. I of the O of 2 Feb 2011, in force since 1 Er March 2011 ( RO 2011 653 ).
Published in the newsletter of the FOPH:
1 New content according to the c. I of O du 2 oct. 2000, in force since 1 Er Jan 2001 ( RO 2000 2835 ).
2 New content according to the c. I of the O of 6 June 2003, in force since 1 Er Jan 2004 ( RO 2003 3249 ).
3 Introduced by c. I of the O of 27 June 2007, in force since 1 Er August. 2007 ( RO 2007 3573 ).
Admission to a list can be accompanied by a limitation. This may relate, in particular, to the quantity or medical indications.
The FOPH may, after consulting the competent committee, issue directives on the form, content and time limit for the submission of applications for the list of specialities and proposals for the list of analyses or the list of Drugs with fares.
The DFI shall, after consulting the relevant committees, issue detailed rules on the preparation of lists, in particular on the content and criteria of the review of the economic nature of medicinal products.
Insurers may jointly process data relating to the type and extent of benefits provided by the various benefit providers as well as to the remuneration charged for those benefits, solely for the purpose of:
1 Benefit providers or their organizations develop designs and programs for quality benefit and quality promotion requirements. The implementing rules (monitoring of compliance, consequences of non-compliance, financing) are regulated in the tariff agreements or in specific agreements relating to quality assurance concluded with insurers or Their organizations. These regulations must conform to generally accepted standards, taking into account the economic nature of the benefits.
2 The parties to the Convention are obliged to inform the OFSP on the provisions in force. The FOPH may require a report on the application of the quality assurance rules.
3 In areas where no agreement has been reached or if the agreement is not in conformity with para. 1, the Federal Council shall issue the necessary provisions. It consults with interested organisations in advance.
4 The DFI shall determine the measures provided for in Art. 58, para. 3, of the law, after consulting the competent committee.
1 Repealed by c. 3 of the annex to the O of 18 Nov 2015 on health insurance surveillance, with effect from 1 Er Jan 2016 ( RO 2015 5165 ).
1 Introduced by c. I of the O of 3 Dec. 2010 ( RO 2010 6155 ). Repealed by c. 3 of the annex to the O of 18 Nov 2015 on health insurance surveillance, with effect from 1 Er Jan 2016 (RO) 2015 5165).
1 Repealed by c. 3 of the annex to the O of 18 Nov 2015 on health insurance surveillance, with effect from 1 Er Jan 2016 ( RO 2015 5165 ).
1 Repealed by c. 3 of the annex to the O of 18 Nov 2015 on health insurance surveillance, with effect from 1 Er Jan 2016 ( RO 2015 5165 ).
1 Introduced by c. I of the O of 3 Dec. 2010 ( RO 2010 6155 ). Repealed by c. 3 of the annex to the O of 18 Nov 2015 on health insurance surveillance, with effect from 1 Er Jan 2016 (RO) 2015 5165).
1 Repealed by c. 3 of the annex to the O of 18 Nov 2015 on health insurance surveillance, with effect from 1 Er Jan 2016 ( RO 2015 5165 ).
1 Introduced by ch. I of the O of 6 June 2003 ( RO 2003 3249 ). Repealed by c. 3 of the annex to the O of 18 Nov 2015 on health insurance surveillance, with effect from 1 Er Jan 2016 (RO) 2015 5165).
1 Repealed by c. 3 of the annex to the O of 18 Nov 2015 on health insurance surveillance, with effect from 1 Er Jan 2016 ( RO 2015 5165 ).
The insurer must clearly distinguish between premiums for each insured:
1 New content according to the c. I of the O of 26 Apr. 2006, effective 10 May 2006 ( RO 2006 1717 ).
Premiums must be paid in advance and in principle every month.
1 New content according to the c. I of the O of 27 June 2007, in force since 1 Er August. 2007 ( RO 2007 3573 ).
1 Paid interest referred to in s. 26, para. 1, LPGA is granted when the insurer recompensates or compensates for overpaid premiums or is required to compensate for the difference in premiums under s. 7, para. 5 and 6, LAMal, provided that the debt exceeds 3000 francs and that it is not paid within six months.
2 The interest rate is 5 % per year. The requirements of art. 7 of the order of 11 September 2002 on the general part of the right of social insurance 2 Are applicable by analogy.
1 Introduced by ch. I of the O of Sept. 11. 2002, effective from 1 Er Jan 2003 ( RO 2002 3908 ).
2 RS 830.11
1 Introduced by ch. I of the O of 26 Apr. 2006 ( RO 2006 1717 ). Repealed by c. I of the O of 24 June 2009, with effect from 1 Er August 2009 (RO 2009 3525).
1 The premium for specific forms of insurance covered by s. 93 to 101 shall be at least 50 % of the premium of the regular insurance with cover of accidents in the premium region and the age group of the insured person.
2 Reductions in premiums for specific forms of insurance covered by s. 93 to 101 shall be fixed so that the reduction related to the suspension of the coverage of accidents may be granted without the premium to a level below the minimum premium set out in para. 1.
1 Introduced by ch. I of the O of 26 Apr. 2006, effective 10 May 2006 ( RO 2006 1717 ).
1 A workforce is considered to be very small within the meaning of s. 61, para. 2, LAMal if the costs of a single insured have a considerable influence on the premiums of the insured persons, in particular if there are fewer than 300 persons. 1
1bis The insurer that starts its business or extends its territorial field of fixed activity for the very low number of employees a premium that is not less than a specified minimum amount. 2
1ter The minimum amount referred to in para. 1 Bis Is the average of all premiums for the current year for the region and age group concerned. The OFSP communicates this amount to insurers each year. 3
2 For persons subject to s. 4 and 5 which are subject to Swiss insurance, the insurer will scale the amount of premiums by region according to their place of residence, if there is evidence that the costs differ according to these regions. If the number of persons concerned makes the exercise disproportionate, the insurer may align the amount of their Swiss premiums with those applicable at the last domicile of the person concerned in Switzerland or at the insurer's headquarters. 4
3 The timing of premiums by age group for insured persons under s. 61, para. 3, of the law is made according to the year of birth.
1 New content according to the c. 3 of the annex to the O of 18 Nov 2015 on the supervision of health insurance, in force since 1 Er Jan 2016 ( RO 2015 5165 ).
2 Introduced by ch. 3 of the annex to the O of 18 Nov 2015 on the supervision of health insurance, in force since 1 Er Jan 2016 ( RO 2015 5165 ).
3 Introduced by ch. 3 of the annex to the O of 18 Nov 2015 on the supervision of health insurance, in force since 1 Er Jan 2016 ( RO 2015 5165 ).
4 New content according to the c. I of the O of 2 nov. 2011, in force since 1 Er Apr 2012 ( RO 2012 955 ).
2 Insurers reduce premiums for the compulsory health insurance of persons who have entered into compulsory insurance under the LAA 3 , for the duration of the accident coverage. 4
3 Insurers may reduce premiums for the compulsory care insurance of persons who have entered into insurance on an optional basis or by convention under the LAA, for the duration of the accident coverage. 5
4 Premiums can be reduced only to the level of the accident coverage, but not more than 7 %. 6
1 Introduced by ch. I of the O of 25 Nov 1996, in force since 1 Er Jan 1997 (RO) 1996 3139).
2 Repealed by c. I of the O of 11 Dec. 2000, with effect from 1 Er Jan 2001 ( RO 2001 138 ).
3 RS 832.20
4 New content according to the c. I of the O of 26 Apr. 2006, effective 10 May 2006 ( RO 2006 1717 ).
5 Introduced by ch. I of the O of 26 Apr. 2006, effective 10 May 2006 ( RO 2006 1717 ).
6 Introduced by ch. I of the O of 26 Apr. 2006, effective 10 May 2006 ( RO 2006 1717 ).
1 DFI periodically checks the suitability of premium regions. The cantons may propose a modification or reduction of premium regions for their territory.
2 The DFI consults with the cantons before amending the delimitation of premium regions.
3 In the event of a merger of municipalities, the canton shall make a proposal to the DFI for the region of premiums to which the new municipality must be attached.
1 Introduced by ch. 3 of the annex to the O of 18 Nov 2015 on the supervision of health insurance, in force since 1 Er Jan 2016 ( RO 2015 5165 ).
1 Repealed by c. 3 of the annex to the O of 18 Nov 2015 on health insurance surveillance, with effect from 1 Er Jan 2016 ( RO 2015 5165 ).
When an insured person is resident abroad, the insurer raises the premiums in Swiss francs or Euros. The insurer can collect premiums by quarter without the insured's consent.
1 Repealed by c. 3 of the annex to the O of 18 Nov 2015 on health insurance surveillance, with effect from 1 Er Jan 2016 ( RO 2015 5165 ).
1 Art. 82 A LAsi 1 And 105 A Of the LAMal shall apply mutatis mutandis to the beneficiaries of the emergency assistance referred to in Art. 82 LAsi.
2 At the request of the canton and at the time indicated by the canton, the maturity of the premiums of a beneficiary of the emergency aid shall be suspended.
3 Where a refund application is made to the insurer and the canton does not itself pay the costs of the benefits which are the responsibility of the compulsory health insurance, the premiums that have been suspended are due with Retroactive effect to the time of suspension. They are due with a supplement of 25 %, but the supplement is due only for a maximum of 12 months of premiums.
4 Once the premiums and supplement have been paid, the Insurer will bear the costs of all benefits provided during the period of the suspension.
5 If the canton so requests, after the payment of the premiums, the participation in the costs and the premium surcharge, the maturity of the future premiums is suspended again.
6 The insured cannot change the insurer, as long as the premiums, cost-sharing and premium are not paid. Art. 7, para. 4, LAMal is reserved.
7 The suspension of the term of the premiums terminates without retroactive payment of the previous premiums as of 1 Er Day of the month in which an insured person:
8 When the suspension of the premium expires in accordance with para. 7, the payment of the previous premiums is due if benefits were requested during the period of suspension. When these premiums are paid, the insured person may change the insurer under the conditions of s. 7 LAMal.
9 The insurance expires five years after the entry into force of the removal order, provided that the person who was the subject of the decision is likely to have left Switzerland.
1 Insurers can practice insurance, in addition to regular care insurance, in which policyholders can choose a higher deductible than the amount set out in s. 103, para. 1 (optionless). Option franchises are 500, 1000, 1500, 2000 and 2500 francs for adults and young adults and 100, 200, 300, 400, 500 and 600 francs for children. An insurer can offer different deductibles for adults and young adults. The optional deductibles offered by the insurer must apply to the entire canton. 1
2 The maximum annual amount of the quota is the amount set out in s. 103, para. 2.
3 If more than one child of the same family is insured by the same insurer, their participation must not exceed twice the maximum amount per child (option deductible and assessed under s. 103, para. 2). If different deductibles are selected for children, the insurer sets maximum participation.
1 New content according to the c. I of the O of 26 May 2004, in force since 1 Er Jan 2005 ( RO 2004 3437 ).
1 All insured persons can join insurance with optional deductibles. The insured cannot choose a higher deductible than for the beginning of a calendar year.
2 The transition to a lower deductible or other form of insurance as well as the change of insurer is possible for the end of a calendar year and on notice given within the time limits laid down in Art. 7, para. 1 and 2 of the Act. 1
3 When an insured person changes an insurer in a calendar year under s. 7, para. 2, 3 or 4 of the Act, he keeps the franchise chosen from the former insurer as long as the new insurer has this form of insurance. Art. 103, para. 4, applies mutatis mutandis. 2
1 New content according to the c. I of the O of 6 June 2003, in force since 1 Er Oct. 2003 ( RO 2003 3249 ).
2 New content according to the c. I of the O of 6 June 2003, in force since 1 Er Oct. 2003 ( RO 2003 3249 ).
1 Premiums for insurance with elective deductibles are based on those of regular insurance. Insurers shall ensure that insured persons in these two forms of insurance contribute, to the extent necessary according to actuarial principles, to the reserves and to the compensation of risks.
1bis Insurers set the amount for which they reduce the premium in accordance with insurance requirements. They shall respect the maximum premium reductions prescribed in para. 2 Bis And art. 90 C . 1
2bis The reduction in premiums per calendar year should not be greater than 70 % of the risk of participating in the costs incurred by insured persons who have chosen a higher deductible. 3
1 Introduced by ch. I of the O of 23 Feb 2000 ( RO 2000 889 ). New content according to the c. I of the O of 26 Apr. 2006, effective May 10, 2006 (RO 2006 1717).
2 Repealed by c. I of the O of 26 Apr. 2006, effective 10 May 2006 ( RO 2006 1717 ).
3 Introduced by ch. I of the O of 6 June 2003 ( RO 2003 3249 ). New content according to the c. I of O of 1 Er Jul. 2009, effective from 1 Er Jan 2010 (RO) 2009 4245).
4 Repealed by c. I of the O of 23 Feb 2000, with effect from 1 Er Jan 2001 ( RO 2000 889 ).
1 Insurers can practice insurance, in addition to regular care insurance, in which a premium reduction is granted when the insured has received no benefits for one year (bonus insurance). The exception is maternity benefits and preventive measures.
2 The calendar year is deemed to be a reference period for determining whether the insured person has received benefits. Insurers may, however, provide for an advanced reference period of up to three months. In this case, during the first year of insurance affiliation with bonus, the reference period is reduced accordingly.
3 The date of the treatment is deemed to be the date on which the insured person received a benefit. Insurers set the period within which the policyholders must remit the invoices to them.
4 Bonuses insurance cannot be performed in conjunction with an optional deductible under s. 93.
1 All insured persons can join insurance with bonus. The transition from regular insurance to bonus insurance is only possible for the beginning of a calendar year.
2 The insured person may enter into another form of insurance or change insurance for the end of a calendar year and on notice given within the time limits laid down in Art. 7, para. 1 and 2 of the Act. 1
3 When an insured person changes an insurer in a calendar year under s. 7, para. 2, 3 or 4, of the law, the new insurer must, if it practices the insurance with bonus and if the insured party adheres to it, take into account the period during which the insurer has not received any benefit in the insurance with bonus of the former insurer. 2
3 Where the insured person is required to change an insurer under s. 7, para. 3 or 4, of the law, the new insurer must, if it practices the insurance with bonus and if the insured adhere to it, take into account the period during which the insurer did not receive any benefit in the insurance bonus of the former insurer.
1 New content according to the c. I of the O of 6 June 2003, in force since 1 Er Oct. 2003 ( RO 2003 3249 ).
2 New content according to the c. I of the O of 6 June 2003, in force since 1 Er Oct. 2003 ( RO 2003 3249 ).
1 Insurers must set premium insurance premiums so that regular and bonus insurance policyholders contribute, to the extent necessary, on the basis of actuarial principles, reserves and compensation Risks.
2 Premiums for insurance with bonuses must be 10 per cent higher than regular insurance premiums.
3 The following fee schedule is applicable:
Premiums Scale |
Bonus % of initial premium |
4 |
0 |
3 |
15 |
2 |
25 |
1 |
35 |
0 |
45 |
4 If, during the calendar year, the insured does not receive benefits, the premium for the following calendar year shall be calculated on the basis of the immediately lower premium level. Only for the reduction of premiums the years of insurance affiliation with bonuses during which the insured has received no benefits are decisive.
5 If, during the calendar year, the insured person benefits from benefits, the premium for the following calendar year increases by one step.
1 Insurers can practice insurance, in addition to ordinary care insurance, involving a limited choice of benefit providers.
2 In insurance involving a limited choice of benefit providers, the insurer may waive all or part of the deductibles and deductibles. 1
1 New content according to the c. I of the O of 17 Sept. 1997, effective from 1 Er Jan 1998 (RO) 1997 2272).
1 All insured persons who reside in the region where the practical insurer has insurance involving a limited choice of benefit providers can join.
2 The shift from regular insurance to insurance involving a limited choice of benefit providers is possible at any time.
3 The transition to another form of insurance as well as the change of insurer are possible only for the end of a calendar year and on notice given within the time limits laid down in Art. 7, para. 1 and 2 of the Act. 1
4 The change of insurer in a calendar year under s. 7, para. 2, 3 or 4 of the Act is reserved. 2
1 New content according to the c. I of the O of 6 June 2003, in force since 1 Er Oct. 2003 ( RO 2003 3249 ).
2 Introduced by ch. I of the O of 6 June 2003, in force since 1 Er Oct. 2003 ( RO 2003 3249 ).
1 Insurance involving a limited choice of benefit providers does not constitute specific risk communities for the same insurer. When setting premiums, the insurer must take account of administrative costs and possible reinsurance premiums and ensure that insured persons who have a limited choice of benefit providers contribute, to the extent necessary According to actuarial principles, reserves and risk compensation.
2 Reductions in premiums are allowed only for differences in costs resulting from the limited choice of benefit providers as well as the specific mode and level of payment for benefit providers. Differences in costs due to favourable risk structures do not qualify for a reduction in premiums. Cost differences must be demonstrated by empirical figures established for at least five accounting years.
3 Where empirical figures have not yet been established for at least five accounting years, premiums may be more than 20 per cent below the regular insurance premiums of the insurer.
4 Where an institution which serves the practice of insurance involving a limited choice of benefit providers provides its benefits to insured persons with a number of insurers, they may fix a uniform premium for those insured persons. Insured.
Insured persons resident in a Member State of the European Union, Iceland or Norway may not adhere to the particular forms of insurance within the meaning of Art. 93 to 101.
1 Introduced by ch. I of the O of 3 Jul. 2001 ( RO 2002 915 ). New content according to the c. I of the O of 2 nov. 2011, in force since 1 Er Apr 2012 (RO 2012 955).
1 Compensation for third parties within the meaning of s. 63 of the law shall not exceed the costs of the tasks entrusted to the third party to the insurer.
2 This compensation is part of the administration costs of the insurer. It should not be passed on to insured persons in the form of a premium reduction.
1 The exemption provided for in s. 64, para. 2, let. A, of the law is 300 francs per calendar year. 1
2 The maximum annual amount of the quota within the meaning of s. 64, para. 2, let. B, of the Act is 700 francs for adults and 350 francs for children. 2
3 The date of the treatment is decisive for the collection of the deductible and the quota.
4 In the case of a change of insurer in a calendar year, the new insurer charges the deductible and the share already charged in that year. Where no deductible or quota has been charged, the deduction is made if the insured provides the corresponding proof.
5 Insurers may charge a deductible and quota for adults whose insurance coverage is scheduled for less than one calendar year, when they claim entitlement to benefits. This package amounts to 250 francs in a 90-day period. It cannot be proposed in relation to particular forms of insurance within the meaning of s. 93 to 101 A . 3
6 A deductible and a flat-rate share shall be levied for insured persons residing in a Member State of the European Union, Iceland, Liechtenstein or Norway and who, during a stay in Switzerland, have the right to international assistance in Benefits under s. 95 A The law. The package is 92 francs for adults and 33 francs for children in a 30-day period. 4
7 The s. 1 to 4 shall apply mutatis mutandis to insured persons resident in a Member State of the European Union, in Iceland or in Norway and who are insured in Switzerland. 5
1 New content according to the c. I of the O of 6 June 2003, in force since 1 Er Jan 2004 ( RO 2003 3249 ).
2 New content according to the c. I of the O of 6 June 2003, in force since 1 Er Jan 2004 ( RO 2003 3249 ).
3 New content according to the c. I of the O of 3 Dec. 2004, in effect since 1 Er Jan 2005 ( RO 2004 5075 ). See also disp. End. Of this mod. At the end of the text.
4 Introduced by ch. I of the O of 3 Jul. 2001 ( RO 2002 915 ). New content according to the c. I of the O of 2 nov. 2011, in force since 1 Er Apr 2012 (RO 2012 955).
5 Introduced by ch. I of the O of 3 Jul. 2001 ( RO 2002 915 ). New content according to the c. I of the O of 2 nov. 2011, in force since 1 Er Apr 2012 (RO 2012 955).
1 The daily contribution to hospital living expenses provided for in art. 64, para. 5, of the law is 15 francs.
2 The following are exempt from this contribution:
1 New content according to the c. I of the O of 3 Dec. 2010, effective from 1 Er Jan 2011 ( RO 2010 6161 ).
2 New content according to the c. I of the O of 29 Nov 2013, in force since 1 Er March 2014 ( RO 2013 4523 ). See also disp, trans. Of this mod. At the end of the text.
1 FAD refers to benefits for which participation in costs is higher within the meaning of s. 64, para. 6, let. A, of the law, and sets the amount of the law. It may also provide that participation is increased when the benefit:
1bis FAD refers to drugs for which a share is higher, within the meaning of s. 64, para. 6, let. A, of the law, and sets the rate of the law. 2
2 When the share is increased relative to that set out in s. 64, para. 2, let. B, of the Act, the amount that exceeds the statutory rate is only half of the maximum amount set out in s. 103, para. 2.
3 FAD refers to benefits for which participation in costs is reduced or eliminated within the meaning of s. 64, para. 6, let. B, of the law. It fixes the amount of the reduced holdings.
3bis The DFI refers to the benefits for which the deductible is removed under s. 64, para. 6, let. D, of law. 3
4 Before enacting the provisions referred to in paras. 1, 3, and 3 Bis , the DFI consults the relevant committee. 4
1 Formerly art. 105.
2 Introduced by ch. I of the O of 9 Nov 2005, in force since 1 Er Jan. 2006 ( RO 2005 5639 ).
3 Introduced by ch. I of the O of 11 Dec. 2000, in force since 1 Er Jan 2001 ( RO 2001 138 ).
4 New content according to the c. I of the O of 11 Dec. 2000, in force since 1 Er Jan 2001 ( RO 2001 138 ).
1 The physician following the pregnancy determines the presumed start of the pregnancy. E Week of pregnancy and mentions it on the invoice.
2 The birth of a stillborn child after 23 E Week of pregnancy is equated with childbirth.
3 The period referred to in s. 64, para. 7, let. B, of the Act ends the 56 E Day after delivery, at midnight.
1 Introduced by ch. I of the O of 29 Nov 2013, in force since 1 Er March 2014 ( RO 2013 4523 ).
The rate of interest rates for premiums due under s. 26, para. 1, LPGA is 5 % per year.
1 The insurer sends the summons in case of non-payment of premiums and contributions to costs within three months of their due liability. It shall be addressed separately from any summons relating to other possible late payment.
2 Where the insured has caused by his fault the expenses which could have been avoided by a payment made in time, the insurer may charge an administrative fee of an appropriate amount, if such a measure is provided for by the general conditions on The rights and obligations of the insured person.
1 New content according to the c. I of the O of June 22, 2011, in force since 1 Er Jan 2012 ( RO 2011 3527 ).
The insurer cannot offset the benefits with premiums or costs that are owed to the insurer.
1 New content according to the c. I of the O of June 22, 2011, in force since 1 Er Jan 2012 ( RO 2011 3527 ).
The canton shall communicate the competent cantonal authority to the insurer.
1 New content according to the c. I of the O of June 22, 2011, in force since 1 Er Jan 2012 ( RO 2011 3527 ).
1 When the insurer announces the debtors to the competent cantonal authority, it shall disclose the following personal data:
2 The canton may invite the insurer not to continue the suit until its decision on the assumption of liability for compulsory health insurance.
1 New content according to the c. I of the O of June 22, 2011, in force since 1 Er Jan 2012 ( RO 2011 3527 ).
1 The Insurer provides, at the end of each quarter, the competent cantonal authority on the development of the acts of default of goods issued since the beginning of the year.
2 It shall announce to the competent cantonal authority, by 31 March at the latest, the final count of the acts of default of property that have been issued during the previous year and the revision report thereon. The count includes the summary of claims for care according to Art. 64 A , para. 3, of the law and a summary of the renditions according to Art. 64 A , para. 5, of the law.
1 Introduced by ch. I of the O of June 22, 2011, in force since 1 Er Jan 2012 ( RO 2011 3527 ).
At the time of the announcement under s. 64 A , para. 3, of the Act, the Insurer provides the following personal data used to identify insured persons and debtors:
1 Introduced by ch. I of the O of June 22, 2011, in force since 1 Er Jan 2012 ( RO 2011 3527 ).
The DFI may lay down technical and organisational arrangements for the exchange of data between cantons and insurers.
1 Introduced by ch. I of the O of June 22, 2011, in force since 1 Er Jan 2012 ( RO 2011 3527 ).
Acts of lack of property within the meaning of s. 64 A , para. 3, of the Act the decisions to grant complementary benefits or equivalent titles which note the absence of the insured's own financial resources. The canton refers to the decisions and titles concerned.
1 Introduced by ch. I of the O of June 22, 2011, in force since 1 Er Jan 2012 ( RO 2011 3527 ).
1 The supervisory body shall verify the accuracy of the insurers' information concerning claims under Art. 64 A , para. 3, of the law. It controls whether:
2 The supervisory body shall verify the accuracy of the indications which the insurers announce to the cantons concerning the payment by insured persons of the debts owing according to the act of default of property.
3 Where the canton designates another supervisory body as the review body according to Art. 86, it shall bear the costs resulting from the activities of the designated control body.
1 Introduced by ch. I of the O of June 22, 2011, in force since 1 Er Jan 2012 ( RO 2011 3527 ).
1 Where personal data and announcements relating to acts of default are received, the competent cantonal authority may transmit to the Insurer personal data according to Art. 105 G Insured persons for whom amounts are covered.
2 The township in which the act of default of property has been established pays the insurer under s. 64 A , para. 4, of the law, the claims until 30 June, after deduction of the retrocession according to Art. 64 A , para. 5, of the law. If the retrocession exceeds the claims, the insurer will refund the balance to the current Township of Residence until June 30.
3 If a retroactive subside is granted for a period covered by an act of default of property assumed by the canton and the communication of the right to the subside by the canton to the insurer takes place before the final count, the insurer deducts the subsidy In question in his next final statement.
1 Introduced by ch. I of the O of June 22, 2011, in force since 1 Er Jan 2012 ( RO 2011 3527 ).
1 The insured person is late payment within the meaning of s. 64 A , para. 6, of the Act upon notification of the summons referred to in s. 105 B , para. 1.
2 If the insured person on late payment requests to change the insurer, the insurer must inform the insurer after receipt of the request that it will not effect any effect if the premiums, the costs and the moratoria interests which have been the subject of the Reminder up to the month preceding the expiry of the period of change or if the prosecution fee in progress to that time is not fully paid before the expiration of that time limit.
3 If the payment was not made in time to the insurer in accordance with para. 2, the latter must inform the insured that he continues to be insured with him and that he will not be able to change the insurer until the next term under s. 7, para. 1 and 2 of the Act. The insurer must also inform the new insurer, within 60 days, that the insured person continues to be insured with the insurer.
1 Introduced by ch. I of the O of June 22, 2011, in force since 1 Er Jan 2012 ( RO 2011 3527 ).
1 If the law of a Member State of the European Union, Iceland or Norway allows the Swiss insurer to recover the premiums and contributions to the unpaid costs, the following provisions shall apply to insured persons resident in that State and Do not pay premiums or interest on matured costs:
2 If the right of a Member State of the European Union, Iceland or Norway in which the insured resides does not allow the Swiss insurer to recover the premiums and contributions to the unpaid costs, the insurer shall send to the insured person who does not pay Premiums or contributions to costs due to a summons, preceded by at least one written reminder. It shall provide it with a period of 30 days and shall inform it of the consequences of late payment. If, in spite of the summons, the insured does not pay within the period allowed for the premiums, the interests in the costs and the stills due, the insurer may suspend the taking of the costs of the benefits. It shall simultaneously inform the insured and the competent mutual aid institution at the place of residence of the insured person of the suspension. The suspension shall terminate as soon as the premiums and contributions to the costs which have been the subject of a summons, as well as the stillous interest, have been paid. When the costs are suspended, the insurer has the right to offset the insurance benefits with premiums or costs which are due to it.
1 Introduced by ch. I of the O of June 22, 2011, in force since 1 Er Jan 2012 ( RO 2011 3527 ).
Persons required to ensure after s. 1, para. 2, let. A and f shall also be entitled to the reduction of premiums, provided that they fulfil the conditions laid down by the canton.
1 New content according to the c. I of the O of 22 May 2002, in force since 1 Er June 2002 ( RO 2002 1633 ).
1 The reduction in premiums is governed by s. 65 A Of the law:
2 When examining the modest economic situation of insured persons residing in a Member State of the European Union, in Iceland or in Norway, the cantons are not allowed to take into account the income and net wealth of the members of the family Subject to the procedure laid down in Art. 66 A The law. 2
1 New content according to the c. I of the O of 2 nov. 2011, in force since 1 Er Apr 2012 ( RO 2012 955 ).
2 New content according to the c. I of the O of 2 nov. 2011, in force since 1 Er Apr 2012 ( RO 2012 955 ).
1 The canton refers to a service that is competent for the exchange of data with insurers according to Art. 65, para. 2, of the law.
2 He announces to the insurer:
3 It fixes the time limits for making the announcements, the ads according to Art. 106 C , para. 1 and 2, and the delivery of the annual count according to Art. 106 C , para. 3.
1 The insurer communicates to the township if it can assign the advertisement to an insured person at home.
2 He shall communicate to the canton the significant changes that have taken place in his dealings with the insured. DFI can define what changes should be considered important.
3 The insurer submits an annual statement to the canton. This includes, for each person entitled, personal data according to s. 105 G , the period concerned, the monthly premium for compulsory health insurance and the amounts paid.
4 It refers to the reduction in premiums per person insured per month on the premium invoice. It should not include the reduction of premiums in the certificate of insurance.
5 It shall pay the insured person the difference within a period of 60 days, if his outstanding debts for the current calendar year and his other outstanding claims for compulsory health insurance, for which he does not exist, are outstanding Of the act of default of goods, are less:
6 The canton may make provision for the insurer to disclose personal data to it according to art. 105 G And other data relating to its insured persons in the canton concerned.
1 Announcements within the meaning of Article 106 B And 106 C Include personal data within the meaning of s. 105 G The Township may provide for the communication of other data.
2 After hearing the cantons and the insurers, the DFI may issue technical and organisational requirements for the exchange and format of the data.
The cantons and insurers bear the costs associated with the implementation of the reduction in premiums.
1 Repealed by c. 3 of the annex to the O of 18 Nov 2015 on health insurance surveillance, with effect from 1 Er Jan 2016 ( RO 2015 5165 ).
Art. 90, 90 A , and 105 A Are applicable by analogy.
1 Introduced by ch. I of the O of Sept. 11. 2002 ( RO 2002 3908 ). New content according to the c. I of the O of 27 June 2007, in force since 1 Er August. 2007 (RO 2007 3573).
Any person who meets the requirements of s. 67, para. 1, of the law may adhere to the insurance of daily allowances under the same conditions as those applicable to other insured persons, in particular as regards the duration and amount of the daily allowance, to the extent that, in all probability, it Does not result in overcompensation.
To the extent that, in an insurance case, sickness insurance benefits are in competition with benefits of the same kind as accident insurance under the LAA 2 , from military insurance, old-age and survivors insurance, disability insurance or the Act of September 25, 1952, on benefits for loss of gain 3 , the benefits of these other social insurance must be given priority. Art. 128 of the order of 20 December 1982 on accident insurance 4 Is reserved.
Insured persons must notify their health insurer of any accident that is not reported to a LAA or military insurance. They must provide all information concerning: 1
1 New content according to the c. I of the O of Sept. 11. 2002, effective from 1 Er Jan 2003 ( RO 2002 3908 ).
1 If, in a case of illness or accident, it is not certain that the obligation to allocate benefits is the responsibility of accident insurance according to the LAA 1 Or military insurance, the sickness insurance may spontaneously advance its benefits, subject to its full right to restitution. 2
2 If a person is insured for daily allowances with several health insurers, each insurer is required to provide benefits.
1 RS 832.20
2 New content according to the c. I of the O of Sept. 11. 2002, effective from 1 Er Jan 2003 ( RO 2002 3908 ).
If the insured person has applied for both the sickness insurance and the invalidity insurance, the sickness insurance must, on an interim basis, provide a guarantee of payment or make payments for the costs of care until determined Insurance that will take charge of the case.
The sickness insurance which advances the benefits shall draw the insured person's attention to the scheme of the reimbursement referred to in Art. 71 LPGA.
1 New content according to the c. I of the O of Sept. 11. 2002, effective from 1 Er Jan 2003 ( RO 2002 3908 ).
1 Repealed by c. I of the O of Sept. 11. 2002, with effect from 1 Er Jan 2003 ( RO 2002 3908 ).
1 Where the sickness insurance has advanced benefits, the other social insurers must pay to the benefit providers the possible difference between the rate applicable to them and the rate applied by the health insurer.
2 When, by applying its tariffs, the sickness insurance paid to the benefit providers more than if it had applied the valid rates for the other insurance, the benefit providers must return the difference to it.
1 If the sickness insurance company wrongly allocated benefits owed by another social insurer or in the opposite case, the unloaded insurer must reimburse the other insurer for the amount it owes, but at most within the limits of its legal obligation.
2 Where several health insurers are entitled to or are required to be reimbursed, their shares are calculated on the basis of the benefits they have or should have allocated.
3 The entitlement to the rebate is limited to five years from the time the benefit is granted.
1 In the current cases, the insurer definitively obliged to pay the benefits shall ensure that they are allocated in accordance with the requirements applicable to it. He shall inform the insured person.
2 In cases where the insured would normally have had to receive higher cash benefits than was actually received by the insurer, the insurer would pay the difference. This rule also applies to cases where the insurance report has expired in the meantime.
1 The insurer obligated to the rebate pays the benefit providers the possible difference between the rate applied by the insurer that is entitled to the rebate and the rate that it applies itself.
2 Where the insurer who is entitled to the refund has paid more than what it should have been by applying the valid rates for the insurer to which the rebate is payable, the benefit providers must return the difference to the insurer.
Insured persons must be informed about the communication of the data (art. 84 A LAMal) and administrative assistance (art. 32, para. 2, LPGA and s. 82 LAMal).
Repealed
1 There is overcompensation to the extent that the respective benefits of social insurance exceed, for the same impairment of health, the following limitations:
2 Where a person is insured with more than one health insurer for daily allowances within the meaning of s. 67 to 77 of the Act, the limits of over-compensation are those of s. 69, para. 2, LPGA. If the benefits are to be reduced, each of these insurers is required to pay the benefits in proportion to the daily allowances that it provides in relation to the total insured per diems.
1 New content according to the c. I of the O of Sept. 11. 2002, effective from 1 Er Jan 2003 ( RO 2002 3908 ).
1 Repealed by c. I of the O of Sept. 11. 2002, with effect from 1 Er Jan 2003 ( RO 2002 3908 ).
When a decision is required under s. 51, para. 2, LPGA, the insurer is required to make it within 30 days.
1 Repealed by c. I of the O of 22 Nov 2000 ( RO 2000 2911 ). New content according to the c. I of the O of Sept. 11. 2002, effective from 1 Er Jan 2003 (RO) 2002 3908).
1 Repealed by c. I of the O of Sept. 11. 2002, with effect from 1 Er Jan 2003 ( RO 2002 3908 ).
1 A fee is levied in the cases referred to in s. 84 A , para. 5, of the law, where the communication of data requires many copies or other reproductions or special searches. The amount of this fee is equivalent to the amount of s. 14 and 16 of the order of 10 September 1969 on costs and allowances in administrative proceedings 3 .
2 A fee-covering fee is charged for publications within the meaning of s. 84 A , para. 3, of the law.
3 The fee may be reduced or remitted if the subject person is in trouble or for other reasons.
1 New content according to the c. I of the O of 22 Nov 2000, in force since 1 Er Jan 2001 ( RO 2000 2911 ).
2 New content according to the c. I of the O of Sept. 11. 2002, effective from 1 Er Jan 2003 ( RO 2002 3908 ).
3 RS 172.041.0
1 Repealed by c. IV 51 of the O of 22 August 2007 on the formal updating of the federal law, with effect from 1 Er Jan 2008 ( RO 2007 4477 ).
1 Sickness insurance may maintain until 31 December 1996 at the latest the insurance reports existing at the time of entry into force of the law with persons who are not subject to compulsory insurance and cannot To be submitted on request. These insurance reports are governed by the former right.
2 A new insurance report within the meaning of para. 1 can only be founded if it allows for the maintenance until 31 December 1996 of a corresponding insurance cover which was guaranteed by an insurer who gave up the practice of social insurance (art. 99-LAMal).
3 Disease-caissae may provide the persons referred to in paras. 1 and 2 to maintain the insurance reports on a contractual basis after 31 December 1996. The contract may be entered into with the same sickness or insurance company or other insurer within the meaning of s. 11 of the Act. The funding of benefits that correspond to those of compulsory health insurance is governed by the principles of social insurance. The insurance reports are subject to the Federal Act of 2 April 1908 on the insurance contract 1 . 2
4 When processing started before 1 Er January 1997 continues after that date, the sickness insurance report must maintain the insurance report under the old right until the end of the treatment. 3
1 Repealed by c. I of the O of 25 June 1997, with effect from 1 Er Jan 1998 (RO) 1997 1639).
1 Suppliers of designated benefits to s. 44 to 54 which, at the entry into force of the Act, carry out health insurance under an authorization granted under the old right shall continue to be entitled to it, if they are admitted under the cantonal law in the following year The coming into force of the Act.
2 Logoperdists/speech therapists and dieticians who only partially fulfil the conditions for the admission of this order, but who have completed their training and practice independently and on their own account Before the entry into force of the law, may carry on health insurance under the new right, if they are admitted under the cantonal law within four years after the entry into force of the law. 1
3 Laboratories already admitted under s. 53 and 54 as benefit providers for the conduct of genetic analyses can continue to perform such analyses until the OFSP authorization decision:
1 New content according to the c. I of the O of 25 Nov 1996, in force since 1 Er Jan 1997 (RO) 1996 3139).
2 RS 810.122.1 ; effective from 1 Er Apr 2007.
3 Introduced by Art. 37 hp. 2 of the O of 14 February 2007 on human genetic analysis, in force since 1 Er Apr 2007 ( RO 2007 651 ).
The conventions provided for in Art. 77, para. 1, must be concluded until 31 December 1997 at the latest.
1 Repealed by c. IV 51 of the O of 22 August 2007 on the formal updating of the federal law, with effect from 1 Er Jan 2008 ( RO 2007 4477 ).
1 The first review of the conditions of admission within the meaning of s. 65 D Was completed in 2016.
2 The provisions of the amendment of 29 April 2015 are also applicable to applications on which the OFSP has not yet decided upon the entry into force of the amendment.
3 Art. 71, para. 2 to 4, is not applicable to the decisions rendered by the OFSP before the entry into force of the amendment of 29 April 2015.
4 Art. 65 D , para. 3, let. C, is not applicable to the review of the economic character of original preparations allowed in the list of specialities before the entry into force of the amendment of 29 April 2015.
5 For medicinal products which have been admitted to the list of specialities before the entry into force of the amendment of 29 April 2015, including the re-examination of the conditions of admission every three years within the meaning of Art. 65 D Has not yet taken place, the repayment of the surplus of income is assessed at the next review of the conditions of admission within the meaning of that Article according to the conditions laid down in Art. 67, para. 2 Ter , from the old right.
(art. 70 B )
In francs |
|
|
|
A. Admission of a drug to the list of specialties or modification of the restriction placed in the list of specialties, if the application is submitted to the Federal Drug Commission |
7500 |
B. Admission of a drug to the specialty list, if the application is not submitted to the Federal Drug Commission |
2500 |
C. Admission of a medicinal product to the list of specialties or modification of the restriction placed in the list of specialities, if the application is processed in fast procedure by the OFSP |
9000 |
D. Price increase |
2500 |
E. Changing the size of the package |
2500 |
F. Modification of dosing |
2500 |
G. Review |
2500 |
|
40 |
1 Introduced by c. II of the O of 8 May 2013 ( RO 2013 1353 ). New content according to the c. III of the O of 29 Apr. 2015, in force since 1 June 2015 (RO 2015 1255).
... 11
1 Formerly an annex.
2 [RO 1964 1296, 1974 978, 1986 685, 1990 1675, 1991 609 2547, 1992 1738 art. 18]
3 [RO 1965 32, 1984 1481, 1990 1674, 1991 606 2546]
4 [RO 1965 45, 1968 43 hp. V 1107, 1969 1147 ch. II, 1974 978 hp. II, 1983 38 art. 142, 1984 1485, 1986 85]
5 [RO 1965 59]
6 [RO 1965 94, 1969 81 ch. II let. B c. 3 1237, 1970 1648, 1984 1479, 1986 80 1706, 1990 21 2039, 1991 370 Annex c. 18]
7 [RO 1966 519, 1971 1186]
8 [RO 1966 590]
9 [RO 1968 1366, 1982 2178, 1984 1486, 1986 89, 1988 1563]
10 [RO 1989 2430]
11 The mod. Can be consulted at the OR 1995 3867.