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:

A. ²

Foreign nationals who have a short-term authorisation or a residence permit, as defined in Art. 32 and 33 of the Federal Act of 16 December 2005 on Foreigners (LEtr) ³ , valid for at least three months;

B. ⁴

Foreign nationals with a dependent activity whose short-term authorisation is valid for less than three months, when they do not have equivalent insurance coverage for treatment in Switzerland;

C. ⁵

Persons who have applied for asylum in Switzerland in accordance with Art. 18 of the Asylum Act of 26 June 1998 (LAsi) ⁶ , persons who have been granted interim protection under s. 66 LAsi and persons for whom provisional admission has been decided in accordance with Art. 83 LEtr;

D. ⁷

Persons residing in a Member State of the European Union who are subject to Swiss insurance under the Agreement of 21 June 1999 between, on the one hand, the Swiss Confederation and, on the other, the European Community and its Member States, On the free movement of persons (Agreement on the free movement of persons) ⁸ And its Schedule II, referred to in s. 95 A, A, of the law;

E. ⁹

Persons residing in Iceland or Norway and who are subject to Swiss insurance under the Agreement of 21 June 2001 amending the Convention establishing the European Free Trade Association (EFTA Agreement) ¹⁰ , from Annex K and Appendix 2 to Annex K, referred to in Art. 95 A , let. B, of the law;

F. ¹¹

Persons who have short-term residence permits or residence permits in accordance with the Agreement on the Free Movement of Persons or the EFTA Agreement, valid for at least three months;

G. ¹²

Persons who engage in a gainful occupation in Switzerland for up to three months and who, under the Agreement on the Free Movement of Persons or the EFTA Agreement, do not need a residence permit, where they do not benefit Equivalent insurance coverage for treatments in Switzerland.

¹ The following are excepted from the obligation to:

A. ¹

Officers of the Confederation, in practice or retired, who are subject to military insurance under s. 1 A , para. 1, paragraph b, c. 1 to 7, and art. 2 of the Federal Military Insurance Act of June 19, 1992 (AML) ² ;

B.

Persons staying in Switzerland for the sole purpose of medical treatment or cure;

C. ³

Persons who, under the Agreement on the Free Movement of Persons ⁴ Annex II of the EFTA Agreement ⁵ , from Annex K and Appendix 2 to Annex K or a Convention on Social Security, are subject to the legal provisions of another State because they engage in a gainful occupation in that State;

D. ⁶

Persons who, because they receive foreign unemployment insurance under the Agreement on the Free Movement of Persons and its Annex II or the EFTA Agreement, Annex K and Appendix 2 to Annex K, are Subject to the legal provisions of another State;

E. ⁷

Persons who are not entitled to a Swiss pension, but who, by virtue of the Agreement on the Free Movement of Persons and its Annex II, are entitled to an annuity from a Member State of the European Union or who, under the EFTA Agreement, from its Annex K and Appendix 2 to Annex K are entitled to an Icelandic or Norwegian pension;

F. ⁸

Persons who are insured as members of the family of persons referred to in the Act. C, d or e, with the foreign health insurance of the latter and who are entitled to mutual assistance in respect of benefits, or Equivalent coverage for treatment in Switzerland;

G. ⁹

Persons who are insured as members of the family of persons with the foreign health insurance of the latter and who are entitled to mutual assistance in respect of benefits.

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

³ ... ¹¹

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

^4bis ... ¹⁴

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 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 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:

A.

The worker was compulsorily insured in Switzerland immediately before the secondment and

B.

That he or she works on behalf of an employer whose domicile or seat is in Switzerland.

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:

A.

Federal officials under the Federal Department of Foreign Affairs (FDFA) who are subject to a regime of change;

B.

Federal agents reporting to the DFAE or another department operating outside Switzerland;

C.

Persons abroad because of their activity on behalf of other Swiss communities or institutions of public law.

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 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 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

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 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

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 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 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 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

A. ⁴

Monitor the consistent application of LAMal and LSA;

B.

Track cost trends;

C.

Control the economic nature of the benefits provided (statistical control of costs based on sex, age, place of residence, benefit provider);

D.

Ensure the equal treatment of insured persons;

E.

Ensure that differences in premiums correspond to differences in cantonal and regional costs and that social insurance resources are exclusively earmarked for the purposes of this;

F.

Preparing the basis for decision-making in order to take ordinary and extraordinary measures under the law for cost containment;

G. ⁵

Observe the effects of the Act and the SAMAL and prepare the basis for decision making for amendments to the Act and the law enforcement provisions that are necessary.

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:

A.

The age, sex and place of residence of the insured;

B.

Admissions and resignposts, and deaths;

C.

Forms of insurance underwritten in the context of social insurance, with an indication of the amount of the premium and the deductible;

D.

The scope, type, tariff headings and costs of benefits provided for in the legislation and which appear on invoices received by the insurer for a full year;

E.

The suppliers of these benefits;

F.

The amount of participation in the perceived costs.

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 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:

A.

Revenues and expenditures;

B.

Result per insured;

C.

Reservations;

D.

Provisions for unliquidated insurance;

E.

Costs of care;

F.

Risk compensation;

G.

Administration costs;

H.

Actual insured persons;

I.

Premiums;

J.

Balance sheet and operating account.

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.

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

A.

Provision of benefits for benefit providers;

B.

Post-graduate degrees and diplomas of benefit providers;

C.

Medical quality indicators;

D.

Extent and type of benefits provided;

E.

Evolution of costs.

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.

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.

Pharmacists with a foreign degree recognized within the meaning of s. 15 LPMed ¹ Or a Cantonal authorization to practice on an independent basis in accordance with s. 36, para. 3, LPMéd, have the same rights as pharmacists with a corresponding federal degree .

Dentists with a federal degree who can provide two-year practical training in a dentist's office or dental institute are eligible.

Dentists with a foreign degree recognized within the meaning of s. 15 LPMed ¹ Or a Cantonal authorization to practice on an independent basis in accordance with s. 36, para. 3, LPMéd, have the same rights as dentists with a corresponding federal degree.

¹ Chiropractors must prove:

A.

They have successfully completed training within the meaning of s. 14 and 33 LPMéd ¹ ; or

B.

They have successfully completed post-graduation training within the meaning of s. 17 to 19 LPMed ²

² ... ³

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 Midwives must:

A. ²

Hold the diploma of a school of midwives recognised or recognised as equivalent by the body designated jointly by the cantons, or a diploma recognised in accordance with the Federal Act of 13 December 2002 on vocational training ³ ;

B.

Have spent two years working with a midwife admitted under this order or in the obstetric division of a hospital or in a specialized medical practice under the direction of a midwife;

C.

Be admitted under the cantonal law.

² ... ⁴

¹ The following persons shall be admitted as persons providing medical prescription care on an independent basis and on their own account:

A.

Physiotherapists;

B.

Occupational therapists;

C.

Nurses;

D.

Logoperdists/orthopaedics;

E. ¹

Dietician.

² Such persons must be admitted under the cantonal law and comply with the other conditions of admission laid down in this order.

¹ Physiotherapists must:

A. ²

Hold the diploma of a recognised or recognised physiotherapy school equivalent by the body designated jointly by the cantons, or a diploma recognised in accordance with the Federal Act of 13 December 2002 on vocational training ³ ;

B. ⁴

Have worked for two years with a physiotherapist or a physiotherapy organization admitted under this order, in a specialized physiotherapy or in a specialized medical practice The direction of a physiotherapist who meets the conditions of this order.

² ... ⁵

¹ Occupational therapists must:

A. ¹

Hold the diploma of a school of occupational therapy recognised or recognised as equivalent by the body designated jointly by the cantons, or a diploma recognised in accordance with the Federal Act of 13 December 2002 on vocational training ² ;

B.

Have worked for two years with an occupational therapist admitted under this order or in a medical practice, hospital or occupational therapy organization under the direction of an occupational therapist who meets the conditions Admission of this order.

² ... ³

Nurses must:

A.

Hold the diploma of a nursing school recognised or recognised as equivalent by the body designated jointly by the cantons, or a diploma recognised in accordance with the Federal Act of 13 December 2002 on vocational training ² ;

B.

Have worked for two years with a registered nurse under this order, or in a hospital or in an organization of home care and support under the direction of a nurse or nurse Meet the conditions for the admission of this order.

Logoperdists/speech-language pathologists must:

A.

Have received three-year theoretical and practical vocational training, recognized by the canton, and have successfully undergone the examination of the following branches:

1.

Linguistic (linguistic, phonetic, psycholinguistic),

2.

Logoped/speech therapy (logopedic/speech therapy method [consulting, logopedic/orthophonic examination, treatment], pedagogy and psychology for people with language difficulties and psychology for people with disabilities Language difficulties, pathology of language),

3.

Medicine (neurology, otolaryngology, phoniatrics, psychiatry, stomatology),

4.

Pedagogy (pedagogy, specialized pedagogy, curative pedagogy)

5.

Psychology (developmental psychology, clinical psychology, pedagogical psychology, including the psychology of learning, social psychology),

6.

Right (social legislation);

B. ¹

Have been engaged in a two-year practice of clinical/speech therapy with essentially an experience in the treatment of adults, including at least one year in a hospital under the direction of a specialized physician (Otolaryngologist, psychiatrist, peopsychiatrist, phoniatrist or neurologist) and in the company of a loggerman/speech therapist who meets the conditions for the admission of this order; a year may have been completed in the office of a physician Specialized, under the direction of the latter and in the company of a logoperdist/orthophonist Which meets the conditions for the admission of this order.

¹ Dietitians must:

A. ²

Hold the diploma of a school of dietetics recognised or recognised as equivalent by the body designated jointly by the cantons, or a diploma recognised in accordance with the Federal Act of 13 December 2002 on vocational training ³ ;

B. ⁴

Have exercised for two years their activity with a dietician or a dietetic organization admitted under this order, or in a medical practice, a hospital or a private or public organization under the direction of a A dietician who meets the conditions for admission to this order.

² ... ⁵

Organizations that provide home care and support are allowed when they:

A.

Are admitted under the legislation of the canton in which they operate;

B. ¹

Have delineated their scope of activity in terms of location, schedule of interventions, care and patients to whom they provide benefits;

C. ²

Have the necessary specialized staff with training that corresponds to their field of activity;

D. ³

Have the necessary equipment because of their field of activity;

E. ⁴

Participate in quality control measures (art. 77) which ensure that their field of activity is fulfilled and that adequate and good quality care is provided.

Organisations of occupational therapy are admitted when they:

A.

Are admitted under the legislation of the canton in which they operate;

B. ¹

Have delineated their scope of activity in terms of location, schedule of interventions, care and patients to whom they provide benefits;

C. ²

Have the necessary specialized staff with training that corresponds to their field of activity;

D. ³

Have the necessary equipment because of their field of activity;

E. ⁴

Participate in quality control measures (art. 77) which ensure that their field of activity is fulfilled and that adequate and good quality care is provided.

Physiotherapy organizations are admitted when they:

A.

Are admitted under the legislation of the canton in which they operate;

B.

Have delineated their scope of activity in terms of location, schedule of interventions, care and patients to whom they provide benefits;

C.

Provide their benefits through persons fulfilling the conditions set out in s. 47;

D.

Have the necessary equipment because of their field of activity;

E.

Participate in quality control measures (art. 77) which ensure that their field of activity is fulfilled and that adequate and good quality care is provided.

Dietetic organizations are admitted when they:

A.

Are admitted under the legislation of the canton in which they operate;

B.

Have delineated their scope of activity in terms of location, schedule of interventions, care and patients to whom they provide benefits;

C.

Provide their benefits through persons fulfilling the conditions set out in s. 50 A ;

D.

Have the necessary equipment because of their field of activity;

E.

Participate in quality control measures (art. 77) which ensure that their field of activity is fulfilled and that adequate and good quality care is provided.

Establishments that are admitted as laboratories are:

A.

Conduct medical analyses;

B.

Are allowed under the cantonal law;

C.

Participate in the measures relating to the guarantee of the quality provided for in Art. 77;

D.

Meet other laboratory requirements under federal or cantonal legislation;

E. ¹

Are authorised by the Swiss Institute for Therapeutic Products Swissmedic (institute), when conducting analyses for the detection of communicable diseases;

E ^Bis . ² Are authorized by the FOPH when conducting human cytogenetic or molecular analyses;

F.

Have adequate facilities and specialized staff;

G.

Fulfil the conditions of admission laid down in Art. 54.

¹ Are admitted without further conditions as medical laboratories:

A.

Medical practice laboratories:

1.

If the analyses are carried out in the context of basic health care based on s. 62, para. 1, let. A, for the physician's needs,

2.

If the results of the analyses are in principle available during the consultation (diagnosis in the presence of the patient),

3.

Whether the medical practice laboratory is an integral part of the treating physician's office, legal and local,

4. ¹

If the analyses are carried out in the medical laboratory or, for the analyses referred to in c. 1 which are designated separately in the context of a home consultation;

B.

Hospital laboratories for analyses that are carried out in the context of basic care (art. 62, para. 1, let. (a) for the purposes of the hospital;

C.

Pharmacists and hospital laboratories for analyses that are carried out in the context of basic care (s. 62, para. 1, let. (a) on the prescription of another benefit provider. ²

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:

A.

They are placed under the direction of a physician, pharmacist, or official with university education in the natural sciences recognized by the DFI;

B.

The person who directs them under the terms of the let. A can justify post-graduate training in laboratory analysis whose contents will be determined by the DFI.

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

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:

A.

Meet the requirements of s. 39, para. 1, let. B to e, the law;

B.

Have defined their scope of activity in accordance with Art. 29 of the Act;

C.

Ensure adequate medical assistance by a midwife;

D.

Have taken steps to deal with medical emergencies.

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:

A.

The economic character and quality of the supply of benefits;

B.

Patient access to treatment in a timely manner;

C.

The availability and capacity of the institution to fulfill the service mandate under s. 58 E .

⁵ In examining the economic character and quality, the cantons shall take particular account of:

A.

The efficiency of delivery of benefits;

B.

The justification of the quality required;

C.

In the hospital area, the minimum number of cases and the exploitation of the synergies.

The schedule is as follows:

A.

For the care needs of insured persons in hospitals for the treatment of acute somatic diseases, as well as in birth homes, planning is linked to benefits;

B.

For the care needs of insured persons for rehabilitation or psychiatric treatment in the hospital, planning is linked to benefits or capacity;

C.

For the health care needs of insured persons in medical and social institutions, planning is linked to capacity.

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:

A.

Exploit relevant information on patient flows and exchange them with the cantons concerned;

B.

Coordinate planning measures with the cantons concerned by them in the coverage of their needs.

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 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:

A.

The tariff shall cover at the most the cost of the provision justified in a transparent manner;

B.

The tariff covers at most the costs necessary for the efficient provision of benefits;

C.

A change in the tariff model should not result in additional costs.

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 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:

A.

The bases and method of calculation;

B.

Instruments and mechanisms to ensure the quality of benefits in the context of the application of the tariff;

C.

Estimates of the effects of the application of the tariff on the volume of benefits, as well as the costs for all areas covered by s. 49, para. 1, of the law, including the areas concerned before and after hospitalization.

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 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.

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 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:

A.

May be performed by the laboratories referred to in s. 54, para. 1, as part of basic care;

B.

May be prescribed by chiropractors in accordance with s. 25, para. 2, let. B, of the Act;

C.

May be prescribed by midwives in accordance with s. 29, para. 2, let. Of the Act.

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 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 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 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:

A.

To admit for a limited duration a medicinal product whose efficacy, adequacy or economic character are being evaluated when there is no therapeutic alternative or the medicinal product promises greater effectiveness compared to the medicinal products Existing treatments;

B.

Require the holder of the authorisation to inform the OFSP when the medicinal product exceeds a certain turnover over a specified period of time. ⁴

Evaluation of the efficacy of allopathic medicines must be based on controlled clinical studies.

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 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:

A.

At least 10 %, where the market volume in Switzerland of the original preparation and its drug in co-marketing does not exceed 4 million francs per year on average during the three years preceding the patent term;

B.

At least 20 %, when the market volume in Switzerland of the original preparation and its drug in co-marketing is between 4 and 8 million francs per year on average during the three years preceding the patent term;

C.

At least 40 %, when the market volume in Switzerland of the original preparation and its co-marketing medicine is between 8 and 16 million francs per year on average during the three years preceding the patent term;

D.

At least 50 %, when the market volume in Switzerland of the original preparation and its co-marketing medicine is between 16 and 25 million francs per year on average during the three years preceding the patent term;

E.

At least 60 %, when the market volume in Switzerland of the original preparation and its co-marketing medicine exceeds 25 million francs per year on average during the three years preceding the patent term. ²

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 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:

A.

Comparison with foreign prices is not possible;

B.

The price is known in less than three of the reference countries;

C.

Comparison with foreign prices was not the sole determining factor in admitting the original preparation in the list of specialties because of its great importance to medical coverage within the meaning of s. 65 B , para. 5;

D.

A decrease in prices due to the extension of the indications or modification of the limitation (Art. 65 F , para. 2, 1 ^Re Sentence) has been taken since the last review of the conditions of admission;

E.

Examination on the grounds of restriction of the indication (art. 65 G ) Has intervened since the last review of the conditions of admission.

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 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 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 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.

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.

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 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 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:

A.

For medicinal products which, according to the classification of the Institute, are given only on prescription:

1.

A premium based on the factory price (price premium), which takes into account, in particular, the capital costs resulting from the management of stocks and unrecovered assets,

2.

A packaging premium which takes into account transport, infrastructure and personnel costs;

B.

For medicinal products which, according to the classification of the Institute, are delivered without a prescription: a premium fixed according to the factory price. ⁵

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:

A.

The drug still meets the eligibility requirements;

B.

At least two years have elapsed since the admission of the medicine in the list of specialities or since the last price increase; and

C.

The new price does not exceed the average price in the reference countries or the comparison with other drugs; if clinical studies provide new evidence of significant improvement in therapeutic progress And that an adaptation of the premium to innovation within the meaning of Art. 65 B , para. 7, therefore, economic character is assessed in accordance with s. 65 B, Al. 5. ⁶

^2bis ... ⁷

^2ter ... ⁸

³ ... ⁹

⁴ ... ¹⁰

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:

A.

Between the day from which the new price should have entered into force in accordance with the decision of the FOPH and the day of the entry into force of the decision, provided that the decision has been confirmed after an appeal having suspensive effect;

B.

During the two years following the decline in the price of a factory under s. 65 F , para. 2, 1 ^Re Sentence, provided that the actual turnover was higher than the expected turnover during the fall in prices.

¹ A medicine from the list of specialties is written off: ¹

A.

The person no longer meets all the conditions of eligibility;

B.

If the price indicated on the current list has been increased without the agreement of the OFSP;

C. ²

If the holder of the marketing authorisation of the original preparation does not comply with the conditions and the charges imposed with the admission (Art. 65, para. 5);

D. ³

If the holder of the marketing authorisation of the medicinal product makes, directly or indirectly, the advertising intended for the public for that medicinal product;

E. ⁴

If the emoluments or fees under s. 71 are not paid on time;

F. ⁵

If the holder of the authorization refuses to provide the necessary documents for the reviews referred to in s. 65 D At 65 G ;

G. ⁶

If the holder of the authorization refuses to repay the excess of income within the meaning of s. 67 A .

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 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

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.

The DFI enacts regulations governing:

A.

Procedure for the admission of a medicinal product to the list of specialities;

B.

Criteria for determining effectiveness, adequacy and economic character;

C. ²

The procedure for the re-examination of the conditions of admission within the meaning of s. 65 D to 65 G ;

D. ³

The procedure for repayment of surplus income within the meaning of Art. 67 A .

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 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 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:

A.

The use of the medicinal product constitutes a necessary prerequisite for the realisation of another benefit which is covered by the compulsory insurance of care and that it is largely predominant; or

B.

The use of the medicinal product allows for a high benefit against a disease that can be fatal to the insured or cause serious and chronic health problems and that, in the absence of a therapeutic alternative, there is no other Authorized effective treatment.

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 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.

Published in the newsletter of the FOPH:

A.

Radiation from the list of specialties;

B. ¹

Other changes to the list of specialties;

C.

Changes to the list of drugs with tariffs that do not require a new version of the list;

D. ²

Changes to the list of analyses that take effect outside the annual parutions;

E. ³

Modifications to the list of means and appliances (art. 33, let. (e) take effect outside the annual parutions.

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.

The insurer must clearly distinguish between premiums for each insured:

A. ¹

Compulsory insurance, the part of the premium for the risk of accident included to be mentioned separately;

B.

Daily allowance insurance;

C.

Supplementary insurance;

D.

Other insurance industries.

Premiums must be paid in advance and in principle every month.

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 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 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 ... ²

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 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.

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 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:

A.

Is admitted on an interim basis under s. 83 LEtr ² ;

B.

Is recognized as a person to be protected under s. 66 ss LAsi or as a refugee under s. 3 LAsi;

C.

Obtains permission to stay.

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 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 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

² ... ²

^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

³ ... ⁴

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 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:

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 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 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 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.

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 The reduction in premiums is governed by s. 65 A Of the law:

A.

For insured persons who receive a Swiss pension, as long as they engage in a gainful occupation in Switzerland or receive a Swiss unemployment benefit;

B.

For insured members of the family of an insured person within the meaning of the whistle. A, even if another insured member of the family collects only a Swiss pension;

C.

For insured members of the family of an insured person who is gainfully employed in Switzerland or who receives a Swiss unemployment insurance benefit, even if another insured member of the family receives only one Swiss pension.

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 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:

A.

Insured persons who are entitled to a reduction in premiums;

B.

The amount of the reduction in premiums by entitlement and per month, rounded to the five cents;

C.

The period in months in which the amount of the premium reduction will be paid.

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:

A.

The reduction of premiums granted by the canton; remain reserved for cantonal regulations which provide that the reduction is equal to the maximum of the total amount of the premium and that the small amounts are not paid;

B.

The lump-sum amount granted by the canton for the compulsory insurance of care according to Art. 10, para. 3, let. D, of the Act of 6 October 2006 on supplementary benefits ¹ .

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.

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

A.

The timing, location, circumstances and consequences of the accident;

B.

The attending physician or hospital;

C.

Potential responsible officials and assurances.

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.

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 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