Federal Office of Private Insurance FOPI
Federal Office of Private Insurance FOPI
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FAQ "Supplementary health insurance"
1. The contract
Do I have to conclude my supplemental insurances with the same insurer as the basic insurance?
No. These are different insurance contracts that may be concluded independently of one another.
What advantages and disadvantages are there if basic and supplemental insurance are bought from two different insurers?
A disadvantage is that the insured person must always ascertain which insurer pays a bill. A financial advantage may be the freedom to transfer the basic insurance to a less expensive insurer.
Are there requirements concerning the term of the contract?
No; the insurer and the client agree on the term of the contract. Terms between one and five years are usual. The contact is automatically renewed if the insured person does not cancel it within the cancellation period.
Are there benefit requirements, or is the insurer free to design the product?
The ICL does not lay down any benefit requirements with respect to health insurance. The health insurance schemes are therefore free in principle to design their products. However, the absolutely and relatively binding provisions of the ICL (see articles 97 and 98) must be respected in developing the products.
Are time-unlimited exclusions of certain pre-existing conditions allowed?
Yes; but they must be clearly indicated in the contract documents.
Is it possible maintain different generations of insurance contract terms and conditions in parallel?
Yes. However, the insured person has the right according to article 35 of the ICL to continue the contract under the new conditions upon request.
2. The premiums
Does FOPI publish the premiums of the supplemental insurances?
No, for two reasons:
About 1000 products with a wide range of benefits are on the market. Indications of premiums without information on the benefits would only be of limited value. In addition, the supplemental insurer is free to conclude a contract with an interested party or not; only basic insurance is subject to compulsory acceptance. A table of premiums would therefore only be a limited decision aid for choosing an insurer.
If the premiums for basic and supplemental insurance continue to rise, I will not be able to afford them. What options do I have to reduce the premiums?
By raising the deductible (annual share of costs borne by the insured person himself or herself), the premiums for basic and supplemental insurance are reduced. Other options are a reduction of benefits, such as switching from private room coverage to semi-private room coverage, or from semi-private coverage to the general division “throughout Switzerland”. Since the supplemental insurances are not mandatory, they may also be cancelled without substitution.
May the supplemental insurer raise the premiums if I conclude the basic insurance with a different insurer?
Some supplemental insurers only grant rebates for supplemental insurance if the basic insurance is also concluded with them. Imposing administrative fees or minimum premiums is also allowed if no basic insurance is included. Advance clarification from the supplemental insurer is recommended.
May premiums be adjusted during the term of a contract?
Yes, if so provided by the terms and conditions of the insurance contract, which is usually the case. Such premium adjustment clauses are allowed by FOPI for reasons of securing solvency. The premium adjustment clause provides that the insured persons must be informed in a timely manner (25-30 days) before entry into force of the premium adjustment. If the insured persons do not agree to the premium adjustment, they have the right to cancel the contract; cancellation is governed by the applicable rule in the terms and conditions of the contract. If the insured person does not make use of this right, the adjustment is considered to be accepted. Any change in rate must be submitted for review by FOPI prior to entry into force.
3. Amendments to the contract
May an insurer cancel my supplemental insurance if I cancel my mandatory basic insurance with that insurer and conclude it with a different insurer?
No. A cancellation of the supplemental insurance on these grounds is expressly prohibited by law.
May an insurer cancel a contract in the case of a claim?
Almost all insurers waive this possibility in the terms and conditions of the contract, although the ICL grants both contracting parties the right to cancel. The terms and conditions of the insurance contract are binding. In any event, the insured person has the right to cancel in the case of a claim, at the latest when the indemnification is paid.
My insurer is offering me a more modern product instead of my existing insurance. Do I have to accept it?
The express consent of the insured person is required for the conclusion of a new product. If the insured person does not give this consent, the insurer must continue the contract under the existing conditions.
An exception applies in cases where the insurer revises its existing products by amending the terms and conditions of the contract. The insurer may offer existing insured persons to continue their existing insurance under the new conditions. As long as the new conditions are not disadvantageous to the insured persons, the insurance is considered to be accepted, unless the insured person expressly rejects the new conditions. In the case of new products, or if a revised product contains changes for the worse, the consent of the insured person is always required for the conclusion of the contract to be valid.
May an insurer change the scope of the insured benefits?
As a rule, no, since contract amendments in the area of private insurance require the express consent of both contracting parties. The sole exceptions are the terms and conditions of the contract that concern a change to the circle of service providers (e.g., hospital lists) or forms of therapy and new medical developments, as well as clauses providing for necessary amendments to the supplemental insurance if the legal catalogue of benefits for basic insurance changes. As in the case of premium adjustments, the insured person again has the right to cancel. These exceptions allow for an ongoing, simple adjustment to medical developments. Additionally, the insurer may influence the service providers in this way to secure the quality of the services, for instance, or to counter excessive fee demands. The amount of the premiums must always be justified by the scope of the insured benefits. FOPI considers farther-reaching contract amendment clauses to be impermissible, such as clauses by which the insurer would reserve the right to unilaterally reduce benefits that are secured by contributions (daily allowances, maximum amounts, etc.).
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